-' '-I'^ -v- :--':v •'."•^•'.'--:: v ; 






« 



8$$ 



» 



amSHw 

Mm 



M# 




i : '.ri 



M»K 



1 



&*&*$» 



&H 



STO 



88 



B 



Si';; 



SSflSg 



■L 



ft 



LWfiwi 



weSS* 






11 HI 



mm 



An 



m 



liinilH 



i 



H 






i^M 






SWK 



&HK 



fO» 



mm 






i 



Hi 



JS®| IS 

: ' i'.;.. ■■■•■' 



■- ., 



ill - : 

TP 




Class JK£AL 
Book__Jf4.1_ 



GqpightN . 



COPyRIGHT DEPOSIT. 





&>c^^(Q^*^^^ 




MEDICAL 



AND 



SURGICAL 

EMERGENCIES 



BT- 



WALTER CLINTON WALKER, M.D. 

Member of the American Association of Physicians and Surgeons, Etc. 

WITH ILLUSTRATIONS 




PUBLISHED BY THE 

W.C.WALKER CO. 

DETROIT, MICHIGAN 



THE LIBRARY OF 
CONGRESS. 

Two Copies Receivec 

SEP 23 1903 

A Copyright Entry 
tLASS CL XXc. No 

Gift u 

COPY 8. 




Copyright, 1903, 



BY 



Walter Clinton Walker, M. D. 






>• • «» ' 



• • • a • • : 

<t • » 1 

• • • • * < 

• ••:■• • < 



■ •• .*« • 



NOTE 

The author has been in general and special practice for 
many years. Having attended the large hospitals of 
Europe, engaged in special work in London, Berlin and 
Paris, he has incorporated the results of his extensive ex- 
perience, both in this country and in Europe, in the pages 
of the accompanying work, in the assurance that it will 
prove of the greatest practical value and assistance in the 
daily life of the household. 



CONTENTS. 

Page 
Frontispiece. 

Preface xi. xii 

Proper selection of your physician. 1-4 

The wonderful construction of the human body — 

The skeleton, tongue, throat, stomach, lungs, heart, blood, 
brain, spine, hand, foot, hair, muscular system, nervous 

system, eye, ear, nose, skin 5-26 

Nursing and care of the child 27-34 

Diseases of childhood — 

Description, symptoms, causes, and treatment 35-72 

Diphtheria 35-41 

Scarlet fever 41-47 

Measles 47-51 

Whooping cough 51-55 

Croup 55-57 

Chicken pox 57-58 

Cholera infantum 58-62 

Mumps 62-63 

St. Vitus' dance or chorea 63-65 

Diseases of the ear 65-66 

Teething 67-69 

Worms 69-72 

Accidents and emergencies 73-109 

How to revive the drowning 76-79 

Poisons and what to do in case of poisoning 80-87 

Sunstroke 88-91 

Hemorrhages or bleeding 92-101 

Medical and surgical emergencies 102-109 

Domestic emergencies and their treatment — 

Cholera morbus, colic, vomiting, diarrhea, croup, whooping 
cough, asthmatic attacks, nervous attacks, toothache, ear- 
ache, poison vine, neuralgia 110-115 

Fractures of bones and dislocations of joints — 

Description, symptoms, causes, and treatment 116-120 

Vomiting 121-122 

Hiccough 122 

Indigestion and biliousness 123 

Vertigo 124-125 

V 



vi CONTENTS. 

Page 

Locomotor ataxia 126-127 

Pulmonary consumption 128-131 

Catarrh of the respiratory tract 132-133 

Asthma 134-135 

Diseases of the heart — 

Description, symptoms, causes and treatment 136-146 

Fatty heart, palpitation of the heart, heart failure, injuries 
to the heart and blood vessels, aneurism, effect of emo- 
tions on the heart, angina pectoris, or neuralgia of the 

heart 136-146 

Diabetes 147-148 

Bright's disease 149-150 

Erysipelas 151-153 

La grippe or influenza 154-156 

Affections of the liver 157 

Functional derangements of the liver 158 

Physiology of digestion 159-160 

Diseases of women 161-167 

Leuchorrhoea '. 161 

Ovarian tumors 162 

Irregular menstruation 164 

Dysmenorrhoea 165 

Menorrhagia 166 

Cessation of menstruation or change of life 166-167 

Drunkenness 168-172 

The use of tobacco 173-175 

Insanity 176-182 

Germ theory in relation to causation of disease 183-194 

Bacteria and their growth 183-189 

Infection and transmission 190-194 

Feeding of sick and preparation of various foods and drinks. . 195-203 

Diet in various diseases 204-205 

Water, its effect and use — 

Cold water, warm water, Russian bath, wet packs, douche, 
sitz and other baths. Hot and cold compresses to various 

parts of the body 206-225 

The hair- 
Growth, loss of hair, blanching, dyeing-. . : 226-251 

Ringworm 251 

Sweating of the feet 251 

Use of spectacles 252 

Electricity in treatment of diseases . 252 

Detection of feigned diseases 255 

Signs of death 256 

Neurasthenia 257 

Neuralgia 258 

Tic Douloureux 259 



CONTENTS. vii 

Page 

Hypochondria 260 

Hysteria 260 

Insomnia 261 

Skin diseases — 

Acne, eczema, hives, itch 262-266 

Bronchitis 266 

Pneumonia 267 

Hay fever 268 

Sick headache 268 

Burns and scalds 269 

White swelling 270-271 

Hemorrhoids or piles 271-272 

Appendicitis 273 

Green sickness or chlorosis 273-274 

Jaundice 275 

Enlarged tonsils '. 276 

Broken breasts 276-277 

Ingrowing toe nail 277 

Preparation of bottled milk 278 

Aphthae 278-279 

Incontinence and retention of urine 279-280 

Vegetarianism 280-282 

The eruptive fevers — 
Scarlet fever, measles, German measles, small pox, vario- 
loid, chicken pox 283-284 

Valuable prescriptions for — 

Bronchitis, catarrh of nose, throat, bronchial tubes and 
lungs, gargles, vapor and spray inhalations, catarrh of 
intestines and bladder, cholera infantum, colic, renal cal- 
culi or gravel, biliary calculi or gall stones, tonics, diar- 
rhea in children and adults, dropsy, mumps, dysmenor- 
rhoea, dyspepsia, inflammation of the bowels, epilepsy, 
carbuncles, chilblains, acute nasal catarrh, influenza, flatu- 
lence 285-307 

Patent medicines- 
Selected prescriptions 308-320 

Pregnancy 321-327 

Suggestions to obstetrical nurse 328-334 

Child bed fever 334 

Rules and diet for lying-in period 334-338 

The value of hygiene 339 

Breathing 339 

Exercise 340 

Infantile indigestion 341-346 

Air and water as remedies 347 

Uric acid producing foods 348 



viii CONTENTS. 

Page 

Massage 349 

Counter irritation 350 

Stammering 351-354 

Bright's disease — 

Proper drinks, foods, etc 355-358 

Small pox — 

Proper management, contagion, disinfection, mortality.... 359-367 

Suggestions to small pox nurse 368-369 

Vaccination 370-371 

Excessive eating as a cause of disease 372-373 

Suggestions concerning education of youth. 374 

Headaches in children 375-377 

Sleep 378-382 

Dreams 383 

Insomnia 383-387 

Prescriptions for headaches* of various origin 388-390 

Nursing — 

Ventilation and warming, open windows, fumigations, health 

of houses 391-398 



LIST OF ILLUSTRATIONS. 

Page 

The Human Skeleton, Fig. 1 6 

The Pelvis, Fig. II 7 

The Stomach, Fig. Ill 8 

The Heaet and Vessels, Fig. IV 11 

Section of Human Brain, Fig. V 12 

The Brain Uncovered, Fig. VI 13 

Muscles of the Side and Back, Fig. VII 16 

The Middle Ear, Fig. VIII 18 

The Muscles of the Eye, Fig. IX 19 

Section of Human Skin, Fig. X 23 

How to Revive the Drowning, Fig. XI, No. 1 77 

How to Revive the Drowning, Fig. XII, No. 2 78 

Compress to Arrest Bleeding from the Arm, Fig. XIII 96 

Compress to Arrest Bleeding from the Hip, Fig. XIII 97 

The Hip Joint, Fig. XV 119 

The Bronchial Tubes and Air Cells, Showing Tubercular 

Deposits, Fro. XVI 129 

The Lungs, Showing Tubercular Disease, Fig. XVII 130 

The Heart, Lungs, Large Vessels and Larynx, Fig. XVIII 137 

Cross Section of the Right Kidney, Fig. XIX 148 

The Right Kidney with its Vessels, Fig. XX 149 

The Liver and Gall Bladder, Fig. XXI 158 

Inside View of Stomach Showing the Gall Bladder and Section 

of Intestine, Fig. XXII 160 

The Womb and its Appendages, Fig. XXIII 164 

The Nervous System, Fig. XXIV 178 

Cross Section of the Spinal Cord, Fig. XXV 180 

Front View of the Internal Organs, Fig. XXVI 185 

Various Disease Germs, Figs. XXVII, XXVIII, XXIX, XXX, 

XXXI 189 

Follicle of Human Hair, Fig. XXXII 232 



IX 



PREFACE. 

During my many years of general family practice, I have been 
called into homes, — sometimes in the dead of night, and out into 
the country; also at other times during the day, when a little 
medical knowledge on the part of parent or other member of 
the family would have prevented the unnecessary and untimely 
call and expense. I have found that often a little common sense and 
practical knowledge, properly applied, was just what was needed. 
I have also seen patients for whom valuable time was allowed to 
go to waste, before it was thought necessary to call the physician, 
generally owing to the lack of seeing the necessity for the 
services of a physician. Often the old adage was found true, 
that "an ounce of prevention is worth a pound of cure." In 
accidents and emergencies, a little knowledge is indispensable, 
as often a life may be saved and great suffering relieved, even 
before a physician can be secured. The baby may be taken with 
croup at night, as this is the time it generally occurs, and untold 
suffering and death may occur, if remedies are not promptly and 
intelligently utilized. Then, a loss of blood may occur from 
a ruptured or injured artery in almost any part of the body, and 
it becomes absolutely necessary that remedies be applied immedi- 
ately by one possessing a little knowledge. The injurious con- 
sequences arising from a neglect of the study of the laws of 
nature, and of obedience to some of the more important ones, 
is often the cause of untold suffering and premature death. Those 
who reach the allotted three score years and ten are generally 
among those who have some knowledge of and obey the laws of 
nature. The statistics of our country show that more than one- 
fourth die in infancy, and not one-half pass the age of ten years. 
The knowledge of natural laws of the human constitution is in- 
dispensable to human happiness. You may possess a wealth of 
earthly goods, but without physical and mental health, your pleas- 
ures are few and sufferings many. 

xi 



PREFACE. 

It has been the object of the author in the preparation of this 
work, to avoid so far as possible, all scientific and technical terms 
and phrases, dealing with the subject in language which all may be 
able to understand, and to furnish such information as will aid the 
reader in the preservation of health, and in early recognition and 
treatment of some of the more common ailments constantly aris- 
ing in the home. 

If this work fulfills the above even to a limited degree, the 
efforts of the author will not have been in vain. 

W. C. WALKER, M. D. 

Detroit, Mich., 1903. 



Xll 



A FEW IMPORTANT SUGGESTIONS WITH 

REFERENCE TO SELECTING YOUR 

PHYSICIAN. 



The choice of a family physician is an important matter, yet it is 
often made in the most haphazard manner. Remember that your 
doctor is to occupy almost the place of a member of your family. 
He will necessarily know most of your private affairs, domestic 
and otherwise. He is to 'be the confidant of your wife, and in 
more than one way, the adviser of your children. First of all, 
you want a skilful man ; second, you need an honorable man ; and 
third, a gentleman. The second and third qualifications are easily 
tested; as to the first you can judge only indirectly. Business 
success is by no means a criterion ; the petted doctor of fashionable 
society is quite apt to be a wily fraud; even the man prominent 
in his own profession may be lacking in the combination of com- . 
mon sense and scientific acumen which makes the ideal physician. 
It is even difficult for one physician to pass a correct judgment 
on another unless he has been intimately associated with him and 
has had the opportunity to watch his work closely. Statistics 
and reports of cures are not a safe basis on which to estimate a 
physician's abilities, for the most dangerous and inevitably fatal 
cases tend to seek the highest medical wisdom. If your selection 
is to be governed by the results of practice, it is far safer to 
choose the man with the largest death rate than the one who 
boasts that he never lost a case. It is generally accepted 
that the physician who has laid a thorough foundation for a 
medical education has most probably been thorough in the super- 
structure of purely technical learning, and that the man whose 
good sense in ordinary affairs is manifest, is likely to display the 
same judgment in the practice of his profession. 

A few dont's may be in order: Don't choose an intemperate 
physician. Don't choose one who has not the respect of his col- 



2 MEDICAL AND SURGICAL EMERGENCIES. 

leagues. Don't tolerate one who is constantly "slinging mud" at 
his brethren. 

In choosing a specialist or consultant, you will naturally be 
guided by the recommendation of your family physician or by 
one's reputation. "Two heads are better than one," and it is no 
act of disloyalty on your part to your own physician, if you 
request the advice of another; and if your doctor is honorable 
and broad-minded, he will cheerfully acquiesce in your desire to 
have the assistance of some one of his colleagues. No self- 
respecting physician can desire to withhold from his patient any 
source of aid, or to retain a patient after the latter has shown 
the least disposition to seek advice elsewhere. 

The obligation between physician and patient is a mutual one. 
The latter expects prompt and efficient service, at the sacrifice of 
convenience, social engagements, and perhaps, of comfort and 
health on the part of the former. On the other hand the physician 
has a right to expect prompt and full payment of financial obliga- 
tions and the consideration of his convenience and recreation 
when emergencies do not prevent. 

Do not expect your physician to diagnose your case in a 
moment. A physician thoroughly familiar with a person's 
temperament, physical condition and previous history, can guess 
very shrewdly at the nature of his trouble, and may be quite 
justified in at once assuring some nervous individual, that he has 
not this, that or the other disease of which he may be fearful. 
But, with such exceptions, the physician who makes a diagnosis 
without a careful investigation, usually including physical, chemi- 
cal or microscopical examinations, or all three, is taking heavy 
risks of being in error. 

A FAI,SE IDEA ABOUT NAMING AU, CASES OF SICKNESS. 

A false idea prevails as to the possibility of assigning names 
to cases. Terms commonly understood, such as diphtheria, croup, 
quinsy, bronchitis, pneumonia, etc., are applicable in only about 
a third of all cases; perhaps another third is covered by purely 
technical expressions, while the remainder embraces cases so ex- 
tremely simple or so complex that they must be described rather 
than named. The attempts of different physicians to translate 



MEDICAL AND SURGICAL EMERGENCIES. 3 

into simple language the technicalities of medical science often lead 
to apparent contradiction and to much undeserved criticism. In 
chronic cases — and these are the very ones which are the most 
apt to apply to a number of doctors — several organs are usually 
simultaneously involved. Different physicians will naturally 
locate the disease in one or another of these organs, and, in the 
attempt to explain the complex relations of one organ to another 
and to give the patient an understanding of a diseased organ, 
when he is ignorant of the action of that organ in health, it would 
be a surprising coincidence if any two doctors used expressions 
which the patient recognized as identical. Neither is the physi- 
cian whose tongue is nimblest in rinding a name always the one 
who best understands the disease. Dyspepsia, for example, is a 
high-sounding title and one which is very satisfying to the aver- 
age patient; but a physician who really understood the stomach 
would feel that he was scarcely nearer the mark in using this term 
than in saying that the patient was sick. Neurasthenia is another 
dainty, diagnostic morsel; but the man who serves it is scarcely 
wiser than the one who says, "I don't know what to call your 
trouble, but you are simply worn out and nervously unstrung, 
and you need a rest." 

Fevers usually divulge their nature little by little. The clinical 
thermometer makes it an easy matter to say whether a patient 
has a fever or not — mere sensations of heat or "feverishness" are 
utterly unreliable — but the question immediately presents itself, 
What kind of a fever? To this question the honest physician at 
his first visit must usually reply "I do not know," unless he has 
been summoned after diagnostic symptoms have developed. Scar- 
let-fever cannot be positively diagnosed in less than twenty-four 
hours, measles in less than three days, typhoid fever in less than 
five or six days. The dislike to avow even a pardonable ignorance 
has led some really honest men to use expressions that are mis- 
leading and untruthful. 

Few persons not thoroughly versed in medical art appreciate 
the true value of medicines. For example, a patient has passed 
successfully through an attack of bronchitis, having taken a cer- 
tain prescription. The common opinion is that the same pre- 
scription will be "good" for another attack of the same disease, 
either in the same or another patient. As a matter of fact, most 



4 MEDICAL AND SURGICAL EMERGENCIES. 

medicines are given without reference to the disease which is in 
progress, but to produce very limited physiological changes or to 
control symptoms which may be common to many diseases. 
There is no disease which can always be appropriately treated by 
the same prescription and only a very few in which a particular 
drug may be said to be specific. It will be readily understood that 
patients of different age, sex and temperament require very dif- 
ferent dosage, but leaving this point aside, the prescription which 
was excellent in one case of bronchitis may be utterly worthless 
or even harmful in another, while it might be well adapted to 
certain cases of pneumonia or gastric catarrh or other conditions. 

In conclusion, it must be borne in mind that tremendous respon- 
sibilities devolve upon the physician, responsibilities which are 
not so much financial as moral. He can no more make restitution 
for an error than can the pilot who has steered the ship on to a 
rock. Accurate knowledge, common sense, a clear brain, self- 
reliance, and absolute conscientiousness, are all needed. 

It is not enough for the physician to do the correct thing. 
Many a patient has been sacrificed through conservatism and fail- 
ure to keep abreast with modern progress, yet no one could say 
that his treatment was unauthorized or wrong. 

The physician whose practice is the crystallized knowledge of 
ten years ago, is no more competent than the pilot who has not 
visited a harbor or river for the same length of time. 

Select your pilot deliberately, having regard both for his ex- 
perience and his technical knowledge; then rely upon his judg- 
ment implicitly, and do not discharge him while in active service, 
unless for the most weighty reasons. 



THE WONDERFUL CONSTRUCTION OF 
THE HUMAN BODY. 

Tongue, Throat, Stomach and Lungs — The Heart and 
the Circulation of the Blood — The Brain and Spinal 
Column — Some Remarkable Laws of Nature — The 
Hand, the Foot — The Muscular and Nervous Systems. 

The human body is a miracle of mechanism. In a marvel- 
ously small space are placed a vast number of cells, pores, tissues, 
muscles and nerves — constant, tireless, faithful servants of the 
body. The life and activities of an entire city are paralleled in a 
minified form in the human body. No work of man can compare 
with it in the exquisite accuracy of its processes, the wondrous 
economy of its workings, the simplicity of its laws, the in- 
genuity of its mechanism, and the perfect harmony and coopera- 
tion of so many varied interests. All this mechanism acts 
automatically and continuously, yet above and beyond this 
human machinery is mind, the wonderful, immortal part of man, 
governing all his activity. 

In the human face there are but seven elements : Forehead, 
eyes, nose, mouth, chin, cheeks and hair. These may be called the 
seven notes of the face. Nature can sing these seven notes in 
but three changes or in three keys : color, size and shape. And 
in using merely these seven notes in three keys she has sung 
billions of human symphonies into the world, without a dupli- 
cate. 

More than half the weight of our bones, three- fourths of the 
weight of our muscles, and seven-eights of our blood, or about 
three-fifths of the weight of the whole body, is water. 

The average weight of a man's skeleton is about fourteen 
pounds, and its height one inch less than the living man. The 
skeleton of the leathery- winged bat is, bone for bone and joint 
for joint, similar to that of man. 

5 



6 MEDICAL AND SURGICAL EMERGENCIES. 




Fig. 1. Human skeleton. 



MEDICAL AND SURGICAL EMERGENCIES. 7 

It is a strange fact that on so simple a question as the number 
of bones in the human body, anatomists are not unanimous. 
The usual figures give the number as two hundred and six, not 
counting the thirty- two teeth. The distribution is : skull, 
twenty- two ; ears, six ; trunk, fifty-four ; upper extremities, 
sixty-four ; lower, sixty. 




Fig. 2. The pelvis. 

Nature abhors a straight line, so there is not a straight bone 
in the whole body. All are bent and twisted — some in two or 
three directions, and the surfaces joining separate bones are 
invariably oblique to each other. 

TONGUE, THROAT, STOMACH AND LUNGS. 

Taste is not equally distributed over the whole tongue. There 
are three distinct regions or tracts, each having its special office. 
The tip of the tongue is concerned with pungent and acid tastes, 
the middle portion is sensitive chiefly to sweets or bitters, while 
the back or lower portion confines itself entirely to the flavors of 
rich, fatty substances. Every piece of food thus undergoes three 
distinct examinations. 

The length of the vocal cords in men and women differs as 
follows : In man, when at rest, their length is about seventy- 
seven-one-hundredths of an inch long. In woman their length 
varies from fifty-one-one-hundredths to sixty-three-one-hun- 
dredths of an inch. 



8 MEDICAL AND SURGICAL EMERGENCIES. 

Though there are only nine perfect tones in the human voice 
there are the astounding number of 17,592,115,044,415 different 
sounds. Of these, fourteen distinct muscles give 16,382, and 
thirty other muscles produce 173,741,823, while all, in co- 
operation, form the above total. 




Fig. 3. No. 1, esophagus, or gullet; 2, the pylorus or lower orifice of the stomach 
entering the intestines; 3, the stomach. 



The stomach, or laboratory where the blood is manufactured 
from food, is a pouch, shaped much like the bag-pipe of the 
Highlanders. In it are numberless lines of little tubes or glands, 
covering the whole interior with these microscopic urns, making 
in all about 5,000,000. Each one of these is a complete chemical 
laboratory, for the manufacture and distribution of gastric 
juice. 

The average man takes five and a half pounds of food and 



MEDICAL AND SURGICAL EMERGENCIES. 9 

drink each day, amounting to one ton of solid and liquid nourish- 
ment annually. In seventy years he eats and drinks one thousand 
times his own weight. 

Every time we breathe, nearly one hundred muscles are em- 
ployed — forty per cent, of the muscles of the body acting in won- 
derful cooperation during this single act. 

The surface of the lungs, if spread flat, would equal 2,642 
square feet. The lungs contain 175,000,000 cells, which, placed 
side by side, would fill a space thirty times greater than that of the 
human body. An adult man respires from sixteen to twenty times 
a minute, or about twenty thousand times a day, the amount of 
air inspired being ten thousand quarts, or eighty barrels, every 
twenty-four hours. In one year 100,000 cubic feet of air are 
drawn into the lungs, and then expelled by nearly nine million 
separate and complicated actions of breathing, to aerate more 
than thirty-five hundred tons of blood. 

the; heart and circulation of the; blood. 

Man has within him a stationary engine called his heart, which, 
with its veins and arteries, constitutes a perfect system of 
hydraulics, compared with which man's best work is clumsy, in- 
tricate, and wasteful. The lungs are automatic bellows, the most 
perfect method of sanitary ventilation. The stomach is a working 
vat of marvelous perfection. The brain is a wondrous condenser, 
and the skin is a great working evaporator, with reserve auto- 
matic appliances, ready for extra work in moments of need. 
Most of these are in action at all times, day and night, tireless, un- 
ceasing, self-winding and repairing, for seventy years, more or 
less. 

The blood in the system is about one-thirteenth of the weight 
of the body. So microscopic is the mesh in this network of capil- 
laries, that touching the body with a needle at nearly any point 
will open a blood vessel. 

Blood consists of a transparent, colorless fluid, the liquor san- 
guinis, and the corpuscles, or minute, solid bodies which float 
in it. The fluid is water, in which are dissolved fibrin, phos- 
phates of soda, albumin, chlorides of sodium and potassium, lime, 
magnesia, and other substances. In every teaspoonful of human 



io MEDICAL AND SURGICAL EMERGENCIES. 

blood there are fifteen billion red blood corpuscles and thirty mil- 
lion white ones, there being three hundred and fifty to five hundred 
times as many red as white corpuscles. The red globules are 
small, bi-concave discs one-thirty-two-hundredth of an inch 
in width. The entire body contains about twenty-six and a half 
million millions, and if placed side by side they would stretch 
130,910 miles, over five times around the earth. 

Nature guards the heart very carefully. It is in a membranous 
bag, which holds it easily and loosely, without impeding its 
motion. This bag contains about a spoonful of fluid to keep the 
heart's surface supple and moist. This sac is placed between 
two soft lobes of the lungs, is tied to strong membranes, and is 
further sustained by the great blood vessels issuing from it. 

The mileage of the blood circulation is astounding. Assuming 
the heart to beat seventy times a minute at ordinary pressure, 
the blood travels at the rate of two hundred and seven yards a 
minute, seven miles an hour, one hundred and sixty-eight miles 
a day, and 61,320 miles a year. In man's allotted life, seventy 
years, the distance traveled by the blood would be 4,292,400 miles, 
or just about eighteen times the distance from the earth to the 
moon. 

In man the average pulse is seventy times a minute ; in 
woman seventy-eight a minute. In a year a man's heart beats 
36,291,240 times, in seventy years it has pulsed 2,540,386,800 
times. It sends through the lungs every day about five thousand 
gallons of blood; every year 1,826,250 gallons, and in seventy 
years 127,837,500 gallons — enough to fill a lake one mile long, 
two hundred and fifteen feet wide and fifteen feet deep. Every 
day the heart does work equal to lifting one hundred and twenty- 
five tons, which in seventy years would be equivalent to raising 
3,193,750 tons. This remarkable work is kept up day and night 
by the heart — a hollow muscle about the size of an adult fist, 
weighing from ten to twelve ounces in a man, and in a woman 
somewhat less. 

Every tooth has an artery to feed the bone, a vein to bring 
back the drained blood, and a nerve for sensation. These three 
pipes entering through a hole in the root of the tooth, when com- 
bined, do not equal the thickness of a horse-hair. 



MEDICAL AND SURGICAL EMERGENCIES. n 




Fig. 4. Heart laid open. No. 1, right ventricle; 2, right auricle; 3, aorta; 
4, pulmonary artery; 5, the apex. 



12 MEDICAL AND SURGICAL EMERGENCIES. 



THE BRAIN AND SPINAL COLUMN. 

In the human brain it has been calculated that the gray matter 
alone contains no less than 600,000,000 cells ; each cell consists 
of several thousand molecules, and each molecule again of many 
millions of atoms. 




Fig. 5. Section of human brain. 

The brain is divided lengthwise into two halves, spoken of as 
the lobes of the cerebrum. Its shape is beautifully exemplified by 
the meat of an English walnut. Each half is practically a replica 
of the other, although in the majority of persons the left half is 
larger than the right half. Each half of the brain governs, or is 
concerned with, the movements and general control of the 
opposite half of the body. The brain has been divided into sec- 
tions, governing ideas and images of distinct classes. Certain 
areas of brain surface are recognized as controlling vision, hear- 
ing, taste, smell and vocal speech, while others govern the muscu- 
lar mechanism of the bodv. 



MEDICAL AND SURGICAL EMERGENCIES. 13 

The average weight of the male brain is forty-nine and a half 
ounces; of the female, forty-four ounces — a difference of over 
five ounces. 

The spine or backbone is a chain of joints consisting of twenty- 
four bones, no two alike, marvelously contrived for an infinity of 
movements, and the harmonizing of manifold and diverse duties. 
It is firm and yet flexible; it is a pipe to convey the important 
medullary substance from the brain; it is a pole from which are 
strung the nerves — the telegraph wires of the body. It is the 
basis from which the muscles of the body take their origin, and it 
is a meeting place and binder for the ribs. No piece of machinery 
made by man can compare with it in ingenuity, simplicity, safety, 
rapidity of action and non-interference of its parts. 




Fig. 6. The brain uncovered. 

The first vertebra is called by anatomists Atlas, because it sup- 
ports the head, as the mythologic Atlas supports the world. 
There are two joints at the neck, one a hinge joint and the other 
a mortise and tenon, by which the head is mounted, as a telescope 
is set on its stand, so that the head can be raised or lowered, 
turned sidewise, and moved backward or forward. 

SOME REMARKABLE LAWS OF NATURE. 

A man will die for want of air in five minutes, for want of sleep 
in ten days, for want of water in a week, and for want of food at 
varying periods, dependent upon circumstances. 



i 4 MEDICAL AND SURGICAL EMERGENCIES. 

The delicacy of the sense of touch is marvelous. The fourth 
jewel wheel-screws of a watch, though they have two hundred 
and sixty threads to the inch, look like dust. They are one-four- 
thousandth of an inch in diameter, and a lady's ordinary thimble 
would hold 100,000 of them ; yet after being hardened and cut 
they are placed by the hand very rapidly in frames, with their 
heads up. This is done by touch alone. 

When one falls asleep the order of surrender to the spell is: 
sight, taste, smell, hearing, touch. The sense of touch is the 
lightest sleeper and most easily awakened, then hearing, then 
sight, while sluggard taste and smell awaken last. 

The human body is an epitome in Nature, of all mechanics, all 
hydraulics, all architecture, and all machinery of every kind. 
There are more than three hundred and ten mechanical movements 
known to mechanics today, and all of these are but modifications 
of those found in the human body. Here are found all the bars, 
levers, joints, pulleys, pumps, pipes, wheels and axles, ball and 
socket movements, beams, girders, trusses, buffers, arches, col- 
umns, cables and supports known to science. At every point 
man's best mechanical work can be shown to be but adaptations 
of processes of the human body, a revelation of first principles 
used in Nature. 

the; hand, the foot, and the hair. 

The average growth of the finger nail is one-thirty-second of 
an inch a week, or a little more than an inch and a half a year. 
The growth is faster in summer than in winter, and varies for 
different fingers. The average time for each finger nail to grow 
its full length is about four and a half months, and at this rate a 
man of seventy would have renewed his nails one hundred and 
eighty-six times. Taking the length of each nail at half an inch 
he would have grown seven feet nine inches of nail on each fin- 
ger, and on all his fingers and thumbs an aggregate length of 
seventy-seven feet six inches. 

In the foot is seen the "mechanical short-cut" of passing one 
tendon through a slit made in another, the long tendon which 
bends the first joint of the toe passing through the short tendon 
bending the second joint, a device allowing the sinew more 
liberty and power. 



MEDICAL AND SURGICAL EMERGENCIES. 15 

The thickness of the human hair varies from one-two-hun- 
dred-and-fiftieth to one-six-hundredth of an inch, blond hair 
being the finest, and red the coarsest. The hair pigment is sup- 
plied by the hair bulb. It is said that hair may turn white during 
violent emotion if the hand be laid upon it. 

By a careful estimate it has been discovered that the number 
of hairs on a well-covered head varies from 90,000 to 120,000. 
Blond hair is generally the most luxuriant, then comes brown, 
then black. On the minimum basis, a woman whose hair is half 
a yard long has about thirty miles of tresses. 

the muscular and nervous systems. 

The muscles are bundles of fibres, each fibre being a bundle of 
fibres, and each of these may be separated, the smallest actual 
fibres being one-four-hundreth of an inch in diameter. Each 
fibre is wrapped in a fine, pellucid sheath, a mere film put around 
it to keep it together. 

There are in the body five hundred and twenty-seven muscles 
— two hundred and sixty-one pairs and five single ones. The 
bones and muscles combined are capable of over twelve hundred 
different movements. 

The muscle which acts upon the heel is one of the largest and 
most powerful in the body, for in raising the heel it has to raise 
the whole weight of the body. 

There are forty pairs of nerves that start from the base of the 
brain and spinal cord, like telegraph wires. These may be called 
the "main lines," and with their connections and branches num- 
ber 10,000,000. The nerve cells — stations or batteries for the 
transfer of power— are millions in number, some of them having 
a diameter of only one-five-thousandth of an inch. 



16 MEDICAL AND SURGICAL EMERGENCIES. 




Fig. 7. External view showing muscles of the side and back. 



THE EYE, THE EAR AND THE NOSE. 

Description of Foreign Bodies and How to Remove Them. 

The eye is a perfect photographer's camera. The retina is the 
dry plate upon which are focused all objects by means of the 
crystalline lens. The cavity behind this lens is the camera. The 
iris and pupil are the diaphragm. The eyelid is the drop-shut- 
ter. The draping of the optical dark room is the only black 
membrane in the entire body. This miniature camera is self- 
focusing, self-loading and self-developing, and takes millions of 
pictures every day, in colors, and enlarged to life-size. 

Charts have been prepared showing that the eye has seven 
hundred and twenty-nine distinct expressions, conveying as many 
different shades of meaning. The eye is subject to forty-eight 
diseases — more than of any other organ. There are 300,000 fibres 
in a single optic nerve. 

The retina of the eye, a continuation of the optic nerve, though 
it is no thicker than a piece of paper, consists of nine distinct 
layers, the innermost composed of rods and cones. These are 
supposed to be the immediate recipients of the undulations of 
light, and are so numerous that in each eye the cones are esti- 
mated at over three million and the rods at over thirty million. 

The power of color perception is overwhelming. To perceive 
red the retina of the eye must receive three hundred and ninety- 
five million vibrations in a second ; for violet it must respond to 
seven hundred and ninety million vibrations in a second. In our 
waking moments our eyes are bombarded every second by at 
least six hundred million million vibrations. 

Each ear contains a perfect miniature piano of about three 
thousand double fibres or strings of unequal thickness and length, 
and stretched or relaxed in unison with exterior sounds. The 
longest cord of this marvelous instrument is about one-fiftieth 
of an inch; the shortest of about one-five-hundreth of an inch. 
2 I? 



18 MEDICAL AND SURGICAL EMERGENCIES. 

The three thousand strings are distributed through a register of 
seven octaves, each octave corresponding to about four hundred 
fibres, every half tone being sub-divided again into thirty-two 
others. The deepest or gravest tone that it is possible for us to 
hear has thirty-two vibrations per second ; the highest, the shrill- 
est, has about seventy thousand. 

The delicacy of the sense of smell almost surpasses belief. A 
single grain of musk has been known to perfume a room for 
twenty years. At the lowest computation that grain of musk 
must have been divided into three hundred and twenty million 
million particles, each individually capable of affecting the organs 
of smell. 




Fig. 8. Middle ear. No. 1, drum membrane; 2, internal bones 
of the ear; 3, external bones of the ear. 



HOW TO REMOVE FOREIGN BODIES IN the eye, NOSE and ear. 

Foreign bodies in the eye. Small substances like cinders, 
dust or small chips of stone or metal, can usually be removed 
from the eye by very simple means. Sometimes there is at once 
a free flow of tears which washes them out. At others, the com- 
mon way of catching the upper eyelid by the lashes and pulling 
it away from the eyeball and down over the lower lid, then letting 
it go so that as it recedes its under surface is swept by the lashes 
of the lower lid, will clear it out. 

If this does not prove successful, a loop made of horse hair, or 



MEDICAL AND SURGICAL EMERGENCIES. 19 

a long human hair, can be passed under the lid and swept, from 
the outer side, toward the nose and drawn down. This may 
serve the purpose. 

If it does not, the upper lid must be everted, or turned inside 
out. This is easy to do. One way is to seize the lashes between 
the tfcumb and first finger, and to draw the edge of the lid away 
from the eye-ball. At the same moment the end of the second 
ringer is pressed against the skin of the lid above its edge. The 
patient is now told to look down, and, as he does so, the lashes 
and edge of the lid are pulled upward toward the eye-brow, while 
the upper part is tucked under it with the end of the second 
ringer. Another plan is to draw the lid down, take a slender 
pencil, or knitting or crochet needle, and place it against the eye- 
lid, parallel to and one-third of an inch above the edge, and then 
to pull the edge up and turn it over this by means of the lashes. 




Fig. 9. View showing muscles of the eye. 

The lower part of the eye is easy to examine, because the lower 
lid is so easy to turn down. 

In this way a large part of the eye-ball and eyelid can be exam- 
ined and any foreign substance removed. A magnifying glass 
is sometimes needed to see fragments that have given a great 
deal of trouble. 

One must be on his guard against the sensation which is some- 
times left after a foreign body has been removed from the eye. 
It often feels to the sufferer as though this were still in his eye 



20 MEDICAL AND SURGICAL EMERGENCIES. 

when it is not. But a most careful search should be made before 
this is taken to be a self-deception; and even then it would be 
better to consult a more skilled person. 

After removing a foreign body from the eye, the irritation may 
be sufficient to demand cool, wet applications, or even anodynes. 
Nothing is better than a thin mucilage of pure, clean gum-arabic 
poured freely in the eye. Or, a little laudanum may be poured 
into a heated cup, and when evaporated to a kind of jelly it can 
be thinned out with clear water and this poured into the eye. A 
bandage, loosely applied so as to shut out light and keep the eye- 
ball rather quiet, often does much good. 

When lime gets in the eye it burns very severely. At once 
the eye should be deluged with water, and a little vinegar or 
lemon juice and water (a teaspoon ful of vinegar or lemon juice 
to a teacup of water) be poured over the eye-ball. 

Foreign bodies in the nose. Children sometimes place, or 
have placed, in their noses small bodies, such as marbles, but- 
tons, peas, beans or small grains. To get rid of them, the nose 
should be blown hard; or sneezing may be excited by tickling 
the nose or giving snufT ; or the child may be told to take a full 
breath and then be given a smart blow on the back. Some one 
of these plans may dislodge the foreign body. If it does not, 
reasonable efforts may be made to fish it out with a bent hair-pin, 
a bodkin, the handle of a mustard or salt spoon, or something 
of that sort. But these efforts must not be rough or prolonged, 
for they may do much damage ; and if a surgeon must be called, 
the sooner it is done the better. The longer it is delayed, the 
harder will be his work and the worse for the child. In case peas 
or beans are lodged in the nose, the danger is increased by the 
fact that if they absorb any moisture, they swell up and are very 
■difficult to get away. 

Foreign bodies in the ear. The removal of foreign bodies 
from the ear is more difficult than when they are in the nose, 
because there is no way of getting at them from behind, and there 
is no natural force to be called to one's assistance. Consequently 
it usually requires special instruments. Yet, if no medical man 
be attainable at all, and if it be remembered that the outer passage 
of the ear is about an inch deep and very delicate, something may 
be done. 



MEDICAL AND SURGICAL EMERGENCIES. 21 

If the body be a metal or mineral one, the ear may be syringed 
out thoroughly. The person's head must be held up with the 
face down, as in this position gravity lends some assistance. 
Very gentle efforts may even be made to remove any foreign 
body with a crochet needle, or a hair-pin, or an ear spoon, if it 
can be had. But with all these it must be remembered that great 
damage may be done by the least roughness. 

If live insects get into the ear, oil, glycerine, or salt and 
water should be poured in. Or a plug of cotton soaked in a 
strong solution of salt and vinegar may be placed in the ear, the 
head being turned over on that side. 

An ingenious method, which has sometimes been successful, 
is to turn the ear at once to a bright light, so as to tempt the 
insect to back out, on account of the attraction which light has 
for all these creatures. 



STRUCTURE OF THE SKIN. 

Chief Function of the Skin — Deformities of the Skin — 
Warts, Moles and Scars, and How to Remove Them. 

The skin consists principally of two layers ; the inner layer is 
called the Corium, or Derma, and the outside layer the Cuticle, 
or Epidermis. Within and beneath the inner layer of the Derma 
are imbedded several organs with special functions, such as the 
sebaceous and sudoriparous, or sweat glands, and little follicles 
for the roots of the hair. The sebaceous glands are abundantly 
distributed over most parts of the body, being most numerous 
in parts largely supplied with hair, as the scalp and face ; they are 
entirely absent from the palm of the hand and surface of the feet. 
The sudoriparous or sweat glands are abundantly distributed 
over the whole surface of the body, and are especially numerous, 
as well as large, in the skin of the palm of the hand and sole 
of the feet. These are the glands from which the peculiar odor- 
iferous matter of the armpit is secreted. 

CHIEF FUNCTIONS OF THE SKIN. 

The skin is tough and elastic ; it readily yields and adapts itself 
to the various movements and changes of position of the body. 
The skin is the chief organ of the sense of touch; its whole sur- 
face is extremely sensitive. During perspiration there exudes 
from the skin and passes off by evaporation a large amount of 
water, an average of two pounds daily; also other organic mat- 
ter; carbonic acid is also given off by the skin, but in much less 
quantities than it is by the lungs. 

DEFORMITIES OF THE SKIN — WARTS, MOLES AND SCARS. 

Any disfigurations, want of proper form or symmetry, irregu- 
larities of face or feature, in fact, anything that destroys beauty, 

22 



MEDICAL AND SURGICAL EMERGENCIES. 23 

are all a life-long menace to those who possess them, unless they 
are removed. Perfect form and beauty of feature are desired by 
every individual, male and female alike, and those not so favored 
naturally use all proper, and not infrequently improper, means 
to attain the appearance which others possess and which they so 
much desire. It is surprising how small a defect will produce a 
great deformity; a mole upon an otherwise comely face becomes 
a great disfigurement. It is laudable to use all proper means to 
look our best. 




Fig. 10. Showing layers of human skin. 

Warts are often found in children ; in some there may be only 
one or two, while in other cases there will be hundreds ; they vary 
in size from a pin-head to that of a silver dollar. They may be 
round, oval or angular in shape ; the surface may be smooth or 
rough ; the color may be that of the normal skin, or vary through 
the different shades of red, brown and black. When occurring in 
elderly people, or if they are subject to irritation, they are liable 



24 MEDICAL AND SURGICAL EMERGENCIES. 

to become the seat of cancerous growth. The cause of warts is 
somewhat obscure; they are often found in several members of 
the same family. 

HOW TO REMOVE THEM. 

Cosmetic purposes call for their removal when situated upon 
the face, hands or parts of the body which are exposed, and by 
the application of proper remedies they can be permanently 
removed. Electricity has been used with good success, or they 
can be removed by surgical measures, or by strong acids, which 
will kill their growth and remove them. In the choice of these 
measures, one should be guided by the location, size and shape 
of the warts. If the warts are numerous, small, and situated 
upon the face, internal treatment should be tried ; Iodine, Arsenic 
and Sulphate of Magnesia have all been used internally and favor- 
able results attained ; Epsom Salts is a remedy that I have found 
of great benefit. It should be given in doses sufficient to relax 
the bowels two or three times a day for several weeks. For 
external use as a local application a solution of Bichloride of 
Mercury, of the strength of one part of Bichloride to five thou- 
sand parts of water is efficacious. 

The application also of Chromic Acid has been found of great 
value, but is quite painful, and on this account is often objected 
to. When electricity is used, and it is probably the best method, 
and causes the least pain, when it is available, better results will 
be found to have been obtained, and there is little, if any, scar 
left. 

MOIvES. 

Congenital deformities of the skin are often met with. 
Moles are disfiguring in proportion to their size, shape and color. 
They vary in size from a pin-head to a surface equal to a third or 
more of the entire body; in color from that of the normal skin 
through different shades of red and brown to black. Some are 
flat and smooth, while others are rough, some are smooth, others 
are hard ; some are hairless, while others are covered with a thick 
growth of strong hairs. Like warts in old people they may 
become the seat of some malignant growth. 

Moles are often found in several members of the same family. 



MEDICAL AND SURGICAL EMERGENCIES. 25 

They should be removed not only for the cosmetic effect, but also 
on account of their taking on a disease growth at some period of 
the person's life. They can be removed by the knife, caustics, or 
by electricity, in much the same manner as was above indicated 
for the removal of warts. 

Scars are the result of injuries, accidental or otherwise. The 
scar resulting from burns and the excision of glands, for instance 
of the neck when the latter becomes diseased, are liable to lead to 
serious disfiguration. The scar left by the Surgeon depends 
upon the skill and care of the operator. Measures that have been 
used for the removal or improvement of these disfigurements are 
two, namely, massage and electricity. The patient may be taught 
to use massage himself, and this can be done by first smearing 
the scar with sweet-oil or lard, or what is better, equal parts of 
lanolin and sweet-oil, or the oleate of mercury, five per cent., may 
be used once a week; these remedies should be rubbed by the 
patient over the part for about ten minutes every day. This must 
be persevered in for weeks and perhaps months before the de- 
sired result will be attained. The earlier the treatment is begun 
the better will be the results. For the application of electricity 
it is necessary to get the instructions from your family physician. 

THE BODY'S HEAT AND COVERING. 

One of the marvels of the human body is the self-regulating 
process by which Nature keeps the temperature, in health, at 
ninety-eight degrees. Whether in India, with the temperature 
at one hundred and thirty degrees, or in the Arctic regions, 
where the records show one hundred and twenty degrees below 
the freezing point, the temperature remains practically steady at 
ninety-eight degrees despite the extremes to which it is subjected. 

Of the total heat given out by the combustion of food man can 
make one-fifth available in the form of actual work, while science 
has never constructed a steam engine that could utilize more than 
one-ninth of the energy of the fuel burnt under the boiler. 

The skin is covered with minute scales like those of a fish. A 
single grain of fine sand would hide one hundred of these tiny 
scales ; yet, small as they are, each is the covering of from three 
hundred to five hundred pores. 



26 MEDICAL AND SURGICAL EMERGENCIES. 

In a square inch of the palm of the hand 3,528 perspiratory 
pores have been counted. On a basis of a fair average of 2,800 
for each square inch of surface, and estimating 2,500 square 
inches as the surface of the body of a man of ordinary height and 
bulk, the number of pores is 7,000,000. If joined together they 
would make a tube twenty-eight miles long. 

The perspiration averages from two to three pounds daily evap- 
oration; every breath throws from the lungs a certain quantity 
of water. Every minute, day and night, the average is preserved 
of eleven grains of water evaporated by the skin, and from four 
to seven grains from the lungs. 



THE CHILD— ITS NURSING AND CARE. 

Death Rate in Infancy — Mortality in Cities — Nursing and 
Care of Children — Milk oe One Cow — Raw or Boiled 
Milk — Cow's Milk as Compared With Human Milk — 
Goat's Milk — Substitutes eor Mother's Milk — Artificial 
Foods — How to Feed Children. 

death rate in infancy. 

The mortality, due to disease of digestion, which occurs during 
the first year of life is about forty per cent, and to diseases of the 
respiratory organs, about twenty per cent. Thus, it will be seen 
by these statistics, gathered from very reliable sources, that sixty 
per cent, of deaths during the first year is due to diseases of the 
stomach, intestines and lungs. During the second year the cause 
of death changed entirely ; it was found that out of forty-five 
deaths from the two causes, namely diseases of the digestive and 
respiration, but nine were due to diseases of the digestion, and 
thirty-six to affections of the respiratory organs. 

mortality in cities. 

In cities we meet with a high rate of mortality from digestive 
disorders in children of more than one year of age, and the sec- 
ond summer, therefore, is regarded with a great amount of 
anxiety. In fact, public opinion looks for a higher rate of mor- 
tality in the second than in the first summer. The second summer 
of a child's life is a period of danger in part only, because of the 
heat, and mostly because of the ignorance and errors in feeding. 
Conscientious and intelligent families, in fair circumstances, are 
not liable to lose their infants in the second summer. Mortality 
diminishes with every day of advancing life ; every additional 
hour a child lives increases its chance for life. Almost one-half 

27 



28 MEDICAL AND SURGICAL EMERGENCIES. 

of the infants who die before the end of the first year do so before- 
they are one month old. The causes of the disease are the more 
active the earlier they are brought to bear upon the young, with 
their low vitality. 

Two conclusions are to be drawn from the above facts. The 
first is that a lessening of early mortality depends upon avoidance 
of diseases of the digestive organs, by necessitating the proper 
feeding of the infant, and this is particularly important during 
the first few months of its life. It has been shown that breast 
milk lowers the rate of infant mortality through the whole of the 
first year. It is very essential during the first few months. The 
second conclusion is the following: That the hygienic rules for 
infants concern digestion, so much so that infant hygiene and the 
hygiene of the digestive organs in infants appear to be identical. 

There is probably no subject of more importance in connection 
with diseases of child-hood than a thorough and intelligent knowl- 
edge of how to care for the infant and child during its first and 
second years. 

NURSING AND CARE) OF CHILDREN. 

The best nutriment for a new born child is undoubtedly the 
milk of its own mother. If it is found that she cannot nurse the in- 
fant, the milk of a properly selected wet-nurse is next desirable, 
and if the latter is not available then the milk of a domestic ani- 
mal must be utilized. Before the wet nurse is engaged, she and 
her child must submit themselves to an examination of their en- 
tire bodies. There should be no abnormalities of the body, and she 
should be free from all kinds of ulcers and other diseases. The 
best age for a wet nurse is between twenty and thirty years. 

milk oF one cow. 

It is desirable that the baby should be fed on the milk of one 
cow exclusively. The milk of the cow is not necessarily uni- 
form and unchangeable. The constituents of the milk from one 
cow vary in composition and in taste, the latter being frequently 
altered by change in feeding. Pasture or dry feeding of the very 
same cow works a great difference in the milk. In some of the 
most careful dairies, established for the purpose of supplying in- 
fants, those in charge insist upon uniform stable feeding through- 



MEDICAL AND SURGICAL EMERGENCIES. 29 

out the whole year. Diseases of the cow influence the milk con- 
siderably ; tuberculosis of cattle is frequent. If the cow from which 
the baby gets its nourishment happens to be diseased, and it is 
overlooked, the results are very much worse than if the child had 
been receiving milk from several animals, that is, the danger would 
not be nearly so great by so doing, and this danger is greatly 
-diminished by getting milk from the whole dairy. 

RAW OR BOILED MILK. 

Boiling the milk removes a small portion of fat and casein 
which is collected on the surface. This loss is desirable, however, 
the quantity thus withdrawn is too small. Boiling retards acidu- 
lation and it becomes either neutral or alkaline through boiling. 
It is true that the taste of boiled milk is less pleasant to most 
people, but its possible dangers are less to all. Milk changes very 
readily; it takes the odor of smelling substances nearby. It will 
carry poison, germs, and microbes, and most of these poisons, if 
not all, are rendered inactive by thorough boiling. 

After having boiled the milk intended for the use of the baby 
during the day, it should be kept in a clean bottle, turned upside- 
down, and placed in a cool place. In this way milk will keep 
longer than when preserved in the usual way. Before being used 
all ought to be heated in a water bath of about the temperature of 
the blood. By repeated heating of the whole amount of the day's 
milk several times during the twenty-four hours fermentation will 
l)e retarded and the milk be more easily digested. 

COW'S MILK AS COMPARED WITH HUMAN MILK. 

The milk of each is peculiarly adapted for the purpose for 
which it was designed. We now know that cow's and human 
milk differ in the total quantities of nutritious materials and in 
their relative proportions. Cow's milk contains less total solids, 
less fat, less sugar and twice as much albumenoids. In cow's 
milk there is a large proportion of the element of nutrition which 
creates and supports muscular energy and activity. In human 
milk there is a larger proportion of sugar and fat. Human 
milk is uniformly and persistently alkaloid. Cow's milk is more 
«or less acid, and its acidity becomes greater the longer it is kept. 



3 o MEDICAL AND SURGICAL EMERGENCIES. 



GOAT S MILK. 

It contains more fat, more casein, more salts, more albumen 
and less sugar than cow's milk. It contains very much more fat, 
casein, albumen and salts than human milk. These are its draw- 
backs for exclusive nutriment, being still more serious than cow's 
milk; besides it has an unpleasant odor. It is seldom taken by 
infants for any length of time without disagreeing with the 
stomach, and it is not nearly so well assimilated as cow's milk. 

SUBSTITUTES FOR MOTHER'S MILK. 

Human knowledge and investigation have been exercised for a 
long time in their efforts to procure food for infants which is 
reliable, but the result of all has been that there is no good equiva- 
lent for mother's milk. The nearest possible equivalent is good 
cow's milk. Many children thrive and grow fat on improper 
food, no immediate harm making its appearance; and still again 
we find many who, though they increase in weight, lay the founda- 
tion gradually for future ailments. For such fatness and rotun- 
dity means too frequently rickets, and a constitution too suscep- 
tible to other diseases of childhood. However, there are many 
examples of infants remaining in good condition after being fed 
on badly selected food. What does this prove? Nothing except- 
ing that the digestive apparatus permits of a certain latitude in 
some cases, and that it is a wise provision of nature that takes 
care of the infant in lieu of the intelligence of those caring for it. 

The important difference between woman's and cow's milk, as 
noted above, is that woman's milk curdles in the stomach in small 
light flakes, while that of the cow coagulates in large compact 
lumps, as will be noticed by the material vomited frequently. The 
loose flakes of woman's milk are easily digested and assimilated; 
the firm lumps of casein and fat of cow's milk are more difficult 
to digest and the gastric juice in the stomach of the little infant 
is incapable of handling it. They are usually vomited up again 
or remain for an indefinite time in the stomach or intestines and 
cause a sour condition, consequently irritation and a general dis- 
turbance of the whole system follows. 

When cow's milk is given I have found the following mixture 



MEDICAL AND SURGICAL EMERGENCIES. 31 

very useful in preventing the souring of the milk: Carbonate of 
soda, one drachm, and water, six ounces. A teaspoonful of this 
is to be added to the milk every time it is taken. When the milk 
is boiled for the day, I make enough of this solution to be added 
to the milk, or when the milk is received during the summer for 
the child's nourishment during the next twenty-four hours, imme- 
diately upon its arrival at the house, by adding two or three table- 
spoonfuls of the soda solution to a pint of milk, and it will prevent 
fermentation and the milk from becoming sour. Children over 
three months old drink cow's milk as it comes from the animal, 
with the simple addition of a small amount of the soda solution. 
When the infant is very young, from one-half to one-third water 
should be added. If the parents are sensible they will abstain 
from giving the child all other kinds of food excepting this milk 
for the first three months. The milk should be boiled immediately 
upon its arrival at the house, which prevents curdling. 

After four months, if it becomes necessary to give the child 
additional nourishment, this can be done by soaking a slice of stale 
bread for fifteen minutes in some cold water. After doing this 
the bread can then be boiled into a uniform broth with six or eight 
ounces of alkaline milk to which a little sugar can be added, 
enough to sweeten. 

ARTIFICIAL FOODS. 

The number of prepared foods on the market is very numerous, 
and the selection of one of them, when it becomes an absolute 
necessity, is very difficult for the mother. A soup made by Prof. 
Liebig, and which has had a very extensive use, is a mixture of 
wheat flour, boiled into a thick soup to which, while still hot, malt 
meal is added. The mixture in a few minutes becomes liquid and 
acquires a sweetish taste. This is the method of preparing Liebig's 
soup. The following is the method prescribed by Liebig himself : 
Half an ounce of wheat flour, one half ounce of malt-meal, seven 
and one-half grains of bicarbonate of potassa, are weighed off; 
they are first mixed by themselves, then with the addition of one 
ounce of water, and lastly with five ounces of milk ; the mixture 
is then heated upon a slow fire and constantly stirred until it 
begins to get thick, and at this period the vessel is removed from 
the fire and the mixture is stirred for five minutes, is again 



32 MEDICAL AND SURGICAL EMERGENCIES. 

lieated, and again removed when it gets thick, and lastly it is 
heated till it boils. The soup is purified from bran by passing it 
through a fine sieve (a piece of fine linen), and now is ready for 
use. Barley-malt can be obtained at any brewery. First it is sepa- 
rated from the impurities, and then ground in an ordinary coffee- 
mill to a coarse meal. The troublesome weighing of the materials 
may be dispensed with; a heaping tablespoonful of wheat flour 
weighs pretty nearly one-half ounce, and a tablespoonful of malt 
meal, not quite so heaped, likewise weighs one-half ounce, and an 
ordinary thimble filled with the solution of the bicarbonate of 
potassa contains nearly fifteen grains. The soup thus prepared 
tastes tolerably sweet and, when properly diluted with water, is 
tolerated even by nurslings. This soup, according to my own ex- 
perience, and that of very many eminent physicians, is the best 
substitute for mother's milk, and has saved the life of many a 
child. 

Condensed milk has also had an extensive use in the nursery. 
For a new-born babe I cause one teaspoonful of the milk to be 
dissolved in twelve of water, and, as the child grows older, the 
amount of water is gradually diminished, so that at the end of the 
first year the child gets one of the preparation to six of water. 
Many children thrive upon this preparation. Recently Nestle's 
Food has been used extensively; in the cake form this composi- 
tion consists of wheat flour, yolk of egg and condensed milk. This 
contains 40 per cent, of sugar, 5 per cent, of fat, 15 per cent, of 
proteine, and 30 per cent, of dextrine. Nestle's Food renders ex- 
cellent service to nursing mothers, who have not enough milk to 
satisfy the increasing demands of the child's appetite. 

HOW TO FEED CHILDREN. 

The manner in which the nutriments are to be administered to 
infants is not immaterial. They may be fed, from the very first 
day of life on, with a small spoon or a cup having a snout, to 
which they readily habituate themselves ; but it is better to use a 
sucking bottle, because with it the facial muscles are exercised in 
an equal manner, as in children at the breast of the mother. 

The simplest form of sucking glasses is a common bottle of 
four to five ounces capacity, with a tolerably narrow neck, upon 



MEDICAL AND SURGICAL EMERGENCIES. 33 

the mouth of which several finely-cut bits of delicate sponge are 
secured by a piece of gauze. These sponges should be changed 
several times daily, and are best preserved in pure cold water. 
When they are made to reach half an inch over the neck of the 
b>ottle, and if the gauze is made properly tense, they will imitate 
the form and consistence of the nipple. 

If these sponges are not good or elegant enough, the bottles 
may be provided with mouth-pieces of gold, silver, tin or bone. 
Children drink very readily out of the perforated caoutchouc caps 
which lately have become so popular, and which are specially 
recommendable on account of their cleanliness. 

A very popular method of feeding infants is by the sugar-teat. 
It is prepared by mixing pulverized sugar-crackers with milk or 
water so as to form a dough, which is then put into a linen rag 
and tied with a string so as to form a ball about the size of a small 
apple. This soft, sweet ball is put into the mouth of the child, 
when it cannot be quieted by the ordinary means, at which it in- 
stantly begins to suck, and thus may be kept quiet for hours. In 
general, nothing more can be said against cleanly-kept, often- 
renewed sugar-teats, than that the cheeks of the child, by the con- 
stant sucking, become enormously distended, and form disgusting 
protuberances when the mouth is closed without them. Usually, 
however, the contents of the rag, from its contact with the warm 
mouth, soon begin to ferment, the mucus of the mouth becomes 
acid, and directly upon that digestive disturbance supervenes, and 
a fungous growth springs up upon the mucous membrane of the 
mouth, which only too often leads to a sorrowful end. It is there- 
fore the duty of every physician to prohibit the use of the sugar- 
teat whenever and wherever possible ; but this, in fact, can be 
more easily advised than accomplished, if we only think of the 
condition of a poor woman who all day long is plagued by a large 
number of small children, and at night, when she and the other 
members of the family absolutely require rest, the crying child 
will not leave her arm. She will then certainly say : "The physi- 
cian gives good advice, not to use the sugar-teat ; he, however, is 
not obliged to carry this crying child about all through the night ;" 
thus not one woman out of a hundred will withhold it from her 
child. 

From the lower classes it will hardly ever be possible to eradi- 
3 



34 MEDICAL AND SURGICAL EMERGENCIES. 

cate this fermenting ball, and among the better classes the child 
has a wet-nurse, or at least proper care, and the sugar-teat is re- 
newed often enough, whereby it is generally rendered harmless. 
So much for the nutrition for the first year of life. 

In the second year, the children may be allowed some soft, 
finely-cut meat. If they have no diarrhea, nor are predisposed to 
it, they tolerate fresh ripe fruit exceedingly well ; on the other 
hand, boiled green vegetables and husk fruits very generally cause 
them indigestion. For a child two years of age, for example, I 
prescribe the following diet : Mornings, between 6 and 7 o'clock 
in summer, or between 7 and 8 in winter, milk-gruel ; between 
9 and 10 o'clock, a piece of wheat bread, with a very little butter 
on it; 12 o'clock, well prepared beef-soup, meat with a little 
gravy, or potato-broth, or in place of the meat a meal-broth pre- 
pared with eggs, but with very little fat, green vegetables very 
rarely and in very small quantities ; afternoon, between 3 and 4, 
bread and milk, in summer bread with fruit; evening, at 7, beef- 
soup or milk-broth. Sugar, in general, agrees very badly with 
children, .and it is highly important for their digestion to habitu- 
ate them to it as little as possible. After the children have passed 
the third year they tolerate all kinds of vegetables, and may, 
when otherwise well brought up, very appropriately be allowed to 
eat at the table with the family; it is only necessary to refuse 
them very salt, sour, and highly spiced victuals ; of all others they 
may partake in moderate quantities. Children should not be al- 
lowed to taste wine till they are fourteen years old, even beer is 
absolutely unnecessary, as likewise are tea and coffee. Home- 
made rye bread should be substituted for the ordinary wheat 
bread. It is well to cause children to eat the entire meal off one 
plate. They should consume all the soup allowed them before they 
can obtain anything from the next dish. Aside from the labor 
saved by not repeatedly changing the plates, children thereby ac- 
quire the good qualification of learning to eat everything and not 
to become lickerish. 



DISEASES OF CHILDHOOD. 

Diphtheria — Symptoms op — Treatment — Nursing — Trache- 
otomy — How to Prevent Diphtheria — Use op Anti-Toxine 
and Results op — Scarlet-Fever — Identical Terms — Causes 
and Symptoms — Beginning op Eruption, Diet and Treat- 
ment, Drinks to be Used, Medical Treatment — Measles — 
Cause, Symptoms, Complications, Treatment, Care op the 
Eyes in Measles — Whooping Cough — Symptoms, Compli- 
cations, How to Recognize, Nature and How it is Spread, 
Treatment and How to Prevent — Croup — Varieties op — 
Treatment — Chicken Pox or Varicella — Treatment — 
Cholera Inpantum — Causes — Symptoms — Treatment — 
Mumps or Parotiditis — Treatment — St. Vitus' Dance or 
Chorea — Symptoms, Course op Disease, Treatment — Dis- 
eases op the Ear in Children — Treatment. 

diphtheria, scarlet-pever, croup, whooping cough, measles.' 
chicken pox, and cholera inpantum. 

Diphtheria is a disease of antiquity. Medical historians trace it 
back, at least as far as the commencement of the Christian era. 
Aretaeus, at the close of the first century after Christ, described a 
malady which occurred chiefly among children and was character- 
ized by a false, white covering over the throat, a foul breath and, 
in some cases, food taken into the mouth and swallowed, would 
return through the nostrils, great difficulty of breathing was ex- 
perienced, often ending in suffocation. Since the commencement 
of the sixteenth century numerous epidemics have been observed 
in both Europe and America, and at the present time it is one of 
the most fatal maladies in both continents; while in many locali- 
ties, especially in large cities, it is always present. The majority 

35 



36 MEDICAL AND SURGICAL EMERGENCIES. 

of cases of this disease occur between the ages of two and ten 
years, under the age of one year the younger the child _ the less 
liability there is to take it, and it rarely ever occurs prior to the 
fourth month. Cases of diphtheria are infrequent after the middle 
period of life and old age is almost entirely free from it. The time 
from exposure to catching the disease is important ; I know of one 
case of a boy nine years of age, who was in the same room about 
one hour on Saturday with another case, he was taken down with 
the malignant form of the same disease. In another case two sis- 
ters, aged seven and five years, resided with their parents in a 
boarding-house. A playmate in the same house had symptoms 
which were supposed to be due to a cold, but which were found to 
he diphtheretic, when one night the throat disease became worse 
and ended fatally the next day. The two sisters were immediately 
removed to a hotel but seven days after the death of the playmate 
in the boarding-house diphtheria commenced in the seven-year-old 
child, the younger sister was then removed to a distant part of the 
same hotel, but on the sixth or seventh day subsequently she also 
became affected with the fatal form of the same disease. Conse- 
quently it is seen that the period between exposure and coming 
down with the disease varies in different cases, but in the majority 
it is from two to eight days, but now and then a case may extend 
even beyond these limits. 

SYMPTOMS OP DIPHTHERIA. 

This is a disease which affects the whole system, but the con- 
dition of the throat is of very great importance, and many mis- 
takes are made even by physicians in not interpreting correctly 
the character of the exudate which is found in the throat in all 
cases of diphtheria. It is a very dangerous disease and misleading ; 
no two cases begin in the same way, every case, as far as the symp- 
toms are concerned, seems to be a law unto itself but, in the ma- 
jority of cases it will begin with a sensation of dryness and tick- 
ling in the throat, with perhaps, slight pain when attempts are 
made to swallow, more or less stiffness along the angle of the jaw; 
swallowing becomes difficult and painful, there may be swelling of 
the glands at the angle of the jaw, but occasionally severe cases 
occur and run their whole course without any external swelling 
of the glands. However, when the disease commences and when 



MEDICAL AND SURGICAL EMERGENCIES. 37 

fully established there will be noticed upon the throat, around the 
root of the tongue and tonsils whitish patches surrounded by 
red and inflamed parts. At this period the membrane can be easily 
removed but will immediately reappear in the same situation. 

The nostrils become clogged, great danger occurs when these 
white patches become general and pass down the throat into the 
windpipe and larynx and obstruct breathing to such an extent that 
the helpless patient dies from suffocation. 

Cause of diphtheria : It is due to an especial poison connected 
probably with bad hygiene; this poison is now known to be con- 
tained in a small germ and this germ may cling to the walls of a 
room for an indefinite period. It is fearfully contagious and may 
be communicated by the breath or membrane, and when one case 
occurs in a family or community there is great liability of other 
cases following, even if the strictest rules of prevention are ob- 
served. It is more intense during cold weather. 

TREATMENT. 

Strict isolation should be enforced, as in the contagious fevers. 
Thorough ventilation should be practiced, and everything coming 
from the patient should be scrupulously disinfected. Fever diet 
must be given, the patient being sustained every two hours as 
in typhoid fever. Free stimulation is usually resorted to, giving 
alcohol, for its effect on the strength, pulse and mind of the patient. 
There is great toleration for alcohol in this disease. 

Very early in the disease, when the membrane is first forming, 
the application of strong astringent solutions is resorted to, but 
after the membrane has formed strong applications are injurious. 
The throat should be then kept disinfected with potassium perman- 
ganate or a solution of salicylic acid (7 per cent) or thymol gr. iv., 
in glycerine and water. Saturated solutions of pepsin, trypsin or 
papain are sometimes sprayed into the throat with the view of 
dissolving the membrane. 

Tracheotomy. When all other remedies have failed, and life is 
fast passing away resort is often made to tracheotomy, and, if 
properly done and at a proper time, many lives are saved which 
otherwise would not be. This operation is simply making a small 
opening in the windpipe to prevent the little patient from dying 



3 8 MEDICAL AND SURGICAL EMERGENCIES. 

from suffocation, as the opening will admit air, and, in quite a 
large number of cases, life will be sustained until the membrane in 
the throat has been dissolved enough to allow breathing through 
the natural channel. A small tube is inserted in the opening in 
the throat and needs careful attention. 

Above all other operations tracheotomy is the one of haste and 
emergency, done in hospitals often by the resident surgeon, at 
any hour, and at a moment's notice. It is an operation of con- 
siderable difficulty and great danger in some cases, needing the 
most careful and efficient nursing if it is to be successful. 

Let us suppose, then, you are left as night nurse in special 
charge of a case of diphtheria. The child is in its little cot or tent, 
the steam kettle is going; you are on the watch. What symp- 
toms will make, you call the doctor? The breathing is labored, 
the voice is harsh, the cough when it comes clanks and clangs with 
a brassy, bell-like note — all this you know ; but if you see the eyes 
becoming lusterless and the whites reddish, the lips blue, and, 
above all, if you see at each breath the ribs lifting and the side 
of the chest tucked in, then see that the physician is sent for. If 
he decides on operating, your chief and most important duty will 
be to hold the child and steady the head and neck. Wrap it up in 
a sheet, so that by pinning the sheet you can restrain its hands and 
limbs; bare the little neck to the chest, hold the head absolutely 
straight, watching the cleft of the chin, in the same line exactly 
with the upper cleft of the breast bone; and to project the neck 
forward, if you have not a little round pillow to put behind it, 
make one of a folded sheet or of your own left arm. 

Remember, absolute steadiness of your hands and of the 
patient's neck. 

Nursing. The operation being over, the nursing falls to you 
under three heads : 

i. The tube. The silver tube is in, both outer and inner; you 
have to keep the outer firmly fastened, and yet not too tight to 
hurt the neck, and you have to take the inner out every few 
minutes to clean from it the thick mucus and keep the breathing 
free — a troublesome, tedious task. 

2. The room. It must be kept warm and moist. You must 
watch your thermometer and your fire and keep it perhaps to 70 
degrees, moist ; your little kettle must be kept going. 



MEDICAL AND SURGICAL EMERGENCIES. 39 

3. Nourishment. You will be told what to give, but you have 
to give it regularly, gently and cleanly. 

Duty to yourself. No nurse should think much of beauty or of 
self-preservation. That is not our business. Still no unnecessary 
risks should be run, and in tracheotomy for diphtheria it is right 
to remind you that you run risks of infection if by any chance the 
membrane or mucus be blown out of the tube with force and 
thus enter either mouth or eyes. When the tube is being inserted 
there is generally a great rush of bloody mucus which is most in- 
fectious ; so keep back your head for it is just the moment when 
you are apt to put it forward most eagerly ; also when cleaning or 
changing the tube, just keep your face out of the direct line of fire. 

Many a good nurse has been off duty for weeks from neglect 
of such simple precautions. 

How to prevent diphtheria. The occurrence of diphtheria in a 
family necessitates the prompt removal of all other children of the 
family, either out of the house or to some remote part of the same 
building, and the proper disinfection of the room and all contents 
of it, such as handkerchiefs, linen, spittoons and clothing of all 
kinds. Clothing on all the children when the disease is first 
noticed should be removed, disinfected and an entire new change 
of clothing upon all those who are removed from the one who is 
affected. Toe much care cannot be taken in this respect, as 
"eternal vigilance" in very many cases has prevented the spread 
of this much dreaded disease. 

When diphtheria is prevalent in a community, indispositions on 
the part of a child, especially when fever is present with some 
derangement in breathing, especially through the nostrils, should 
at once arrest attention, although there may be no soreness in the 
throat at this time, but the latter should be carefully examined, 
and if even redness is present the throat should be sprayed with 
some of the following remedies : 

Carbolic acid, 32 drops. 
Glycerine, 2 oz. 
Lime water, 5 oz. 

This should be mixed together and should be used with a hand 
atomizer every two hours through the day. Another preparation 



40 MEDICAL AND SURGICAL EMERGENCIES. 

which is also excellent and has been in use extensively in the 
hospitals of New York city : 

Carbolic acid, 32 drops. 
Chlorate of potassium, 3 drachms. 
Glycerine, 3 oz. 
Water, 5 oz. 

Both these preparations can be used in the same manner, by 
opening the mouth of the child and throwing the spray into the 
throat, or the same can be used by painting the throat with a 
camel's-hair brush, or they can be used as a gargle, if the patient 
is old enough and capable of taking a mouthful into the throat, 
holding it there and gargling. 

Another preparation which has been used extensively during the 
last few years, with excellent results is peroxide of hydrogen. For 
a child from five to ten years old, this can be used, diluted with 
one-half of water. This also can be used as a gargle, with the 
spray atomizer, or with camel's-hair brush, similar to the other 
remedies, mentioned above. 

There are no domestic remedies which can be used safely in this 
disease. Nursing is very valuable. The strength of the patient 
must be kept up and there is nothing better to accomplish this end 
than beef-tea and egg-nog, made properly and given frequently. 

THE USE OP ANTITOXIN IN DIPHTHERIA — HOW IT IS PRODUCED 

THE RESULT OP ITS USE IN HOSPITALS. 

This remedy, as its name implies, is intended to counteract the 
poison of diphtheria. It is very interesting and instructive to 
understand in a general way how antitoxins are obtained, and how 
they are supposed to act when utilized in this disease. 

The first step in the production of antitoxin is to obtain the 
poison of diphtheria from the membrane of the throat, and by 
means of a sterilized platinum rod to transfer it to what is known 
as a cultivating medium. In the latter the microbes propagate; 
this cultivating medium is generally composed of gelatine. After 
the propagation of the microbes takes place, filtration is practiced, 
and the genuine poison, or toxin, is obtained, and is then used for 
the inoculation of animals. 



MEDICAL AND SURGICAL EMERGENCIES. 41 

At the present time the horse is the chosen animal for inocula- 
tion. The animal is inoculated at stated times until it no longer 
reacts to the effects of the progressively increasing doses. Then 
the condition of what is popularly known as immunity is reached ; 
which is simply the impossibility, by the inoculation of these 
poisons, of making the animal sick. 

After the animal is thoroughly immuned (proof from effects of 
the disease), the watery element of the blood of the animal is then 
used for a human patient, who, through the introduction of this 
element into the human system, is guaranteed against the poison- 
ous influences of diphtheria. The horse does not suffer and the 
results on the human patient have been quite satisfactory, and it 
has been the means of saving many lives. 

This remedy, during the last year or more, has been used ex- 
tensively in European hospitals as well as American, and the 
results have been very satisfactory. At Harper Hospital in 
Detroit, this state, where formerly the mortality ranged from 30 
to 40 per cent., with the proper use of antitoxin the mortality was 
reduced to five per cent. 

SCARLET-FEVER. 

The terms scarlet-fever, scarlet-rash, and scarlatina are identical, 
that is, these terms represent the same disease. Scarlet-fever is a 
very frequent and fatal contagious disase. It may occur at any 
age, but occurs most frequently in the young. It is frequent in 
cities, large towns and villages where it spreads by contact. There 
is probably no disease of childhood which is more treacherous, 
and which is approached by physicians with more dread than a 
severe case of scarlet fever. Complications may occur in any form 
of scarlet-fever, but they are most frequent in severe forms. The 
most serious complication which affects the nervous system, is 
convulsions. They may occur at the commencement of the disease, 
before the appearance of the rash and in these cases many of them 
recover. But when the convulsions occur after the rash has 
covered the body, then they are very serious and it has been the 
experience of many physicians, of wide experience, that cases 
never recover when convulsions occur after the rash has com- 
pletely developed. These convulsions are, no doubt, due to the 
congested condition of the nervous system, and the convulsions 



42 MEDICAL AND SURGICAL EMERGENCIES. 

aggravate the congestion. Diphtheria may also complicate scarlet- 
fever, and it is absolutely necessary to make daily examinations of 
the throat in order to detect any complication of this character. 
Another complication to which we may allude is inflammation of 
the bowels, this ma, occur before the scarlet- fever or it may occur 
at the same time. Bronchitis and pneumonia, a frequent compli- 
cation of measles, do not often complicate scarlet-fever. Another 
frequent complication is rheumatism ; it may occur when the fever 
is leaving the patient. Attention is called to it by the child com- 
plaining of pain or tenderness in the affected joints. If the child is 
too young to complain, evidence of pain and tenderness will be 
manifested when the limbs are moved or pressed upon. There is 
also some swelling and redness in those parts. Complication from 
rheumatism is not necessarily serious nor does it retard recovery 
very much, unless some heart complication ensues. Other compli- 
cations are the following: inflammation of the covering of the 
bowels (peritonitis), of the covering of the lungs (plueritis) and 
of the heart (pericarditis) and many such complications of the 
latter are fatal. One of the most common complications and one 
which requires close attention from both physician and nurse is 
inflammation of the kidneys, which is the cause of dropsy. Inflam- 
mation of the ear is also a frequent complication ; matter will form 
in the interior of the ear and there will be a foul-smelling dis- 
charge, which will require constant treatment and attention. 

THE CAUSE OF S CAREET- FEVER. 

It is a very contagious disease. By contagion we mean being 
transferred from the sick to the healthy. When the disease spreads 
in a family or in a community it must be communicated or carried 
in some way ; it may be conveyed by coming in direct contact or it 
may be spread through the atmosphere, or by clothing which has 
been saturated with the poison of scarlet-fever. Animals such as 
dogs have been known to be around the sick-room where scarlet- 
fever existed and to convey it to other families ; a case is known in 
which the poison was conveyed in this way. For a number of days 
a little dog had been around children sick with scarlet-fever and by 
a single visit of a dog to the children of another family the disease 
was conveyed. It is a question at the present time whether or not 
this disease can be transferred in milk. 



MEDICAL AND SURGICAL EMERGENCIES. 43 

PERIOD OF exposure:. 

The period from exposure until the occurrence of the disease 
varies from two to ten days, the average is from three to five. It 
may occur in a few hours after exposure. Age has a marked influ- 
ence, also individual predisposition. Children are the most suscep- 
tible to the influence of the poison between the second and seventh 
year, and as years increase the susceptibility decreases. When an 
individual has had one attack he is almost certain never to have 
another. 

SYMPTOMS OP SCARLET- FEVER. 

The symptoms vary with the severity of the fever. In moderate 
cases before the appearance of the eruption the patient will have 
more or less headache, pain in back and limbs, and, at first, cold- 
ness of the surface of the skin. Sometimes there will be bleeding 
from the nose ; in other cases there will be a chilly sensation, and 
in some, a distinct chill and in children, convulsions frequently 
occur. These symptoms are immediately followed by a sensation 
of intense heat with a rapid pulse, often from one hundred and 
twenty to one hundred and thirty per minute. There will be some 
nausea and vomiting, very distressing and persistent. The tem- 
perature may run high, at the outset from 100 to 104 degrees. 

BEGINNING OF THE ERUPTION. 

Within a period lasting from twelve to forty-eight hours, the 
average being thirty-six, the eruption makes its appearance and 
the fever increases. There is extreme restlessness, often some 
delirium, and nausea and vomiting becoming severe. The tongue 
will indicate a strawberry appearance, unlike any other disease, 
in this respect. 

In some cases the disease is so mild that there is but little dis- 
turbance except that caused by the eruption, the temperature not 
running over 104 degrees, Fahrenheit. In other cases the disease 
is ushered in by violent nervous symptoms, with delirium and 
sometimes a dull and drowsy, almost unconscious condition, 
accompanied by extreme exhaustion, and in some cases, the patient 
dies before the eruption makes its appearance, when the system is 



44 MEDICAL AND SURGICAL EMERGENCIES. 

overwhelmed by the poison from scarlet-fever. During the earlier 
stages both children and adults complain of a prickling sensation 
in the throat, with some difficulty in swallowing. The throat be- 
comes red and congested, and often somewhat swollen, although 
there are some cases in which the throat symptoms are entirely 
absent at the first and do not come on until later in the disease. 

In an ordinary case of scarlatina or scarlet- fever, which runs the 
ordinary course, between the fifth and eighth days of the eruption 
the temperature begins to decline and at the same time the erup- 
tion begins to fade, so that on the eighth day, and sometimes as 
early as the sixth, it is no longer visible. Then sets in what is 
known as the period of desquamation, that is, the peeling of the 
. cuticle or outer layer of skin. This period lasts about two weeks, 
and during this period there is the greatest danger of the spread- 
ing of the disease, but at the end of this period, if no complications 
occur, the patient may be considered practically well. 

These fine particles which are thrown off from the skin contain 
the specific poison of scarlet-fever and they are so fine and 
so delicate that they may be blown about with every breath and 
carried with every current of air, so that an average case of scarlet- 
fever will come to an end at about the fourteenth day, sometimes 
as early as the tenth day. 

TREATMENT OF SCAREET-EEVER. 

Strict observance must be enforced in relation to the separation 
of the healthy from the one affected. Thorough ventilation of the 
room ought to be practiced and disinfection should be thoroughly 
carried out. All useless articles of furniture must be removed from 
the sick-room, fresh air be admitted as much as possible, as it ren- 
ders the contagion of scarlet-fever less powerful ; therefore free 
ventilation is very important. All clothes and excretions of the 
patient should be disinfected in the same manner as in typhoid 
fever. The surface of the body should be frequently sponged and 
after sponging, the surface should be rubbed with olive oil. These 
details should be practiced and carried out during the period of 
desquamation. Those convalescing should not be allowed to leave 
their room until desquamation is completed, which usually re- 
quires from two to three weeks. After the patient leaves the sick- 
room the apartments should be thoroughly disinfected, and the 



MEDICAL AND SURGICAL EMERGENCIES. 45 

-windows and doors of the room should be allowed to remain open 
for a long time. 

DIET IN SCARI^T-FEVER. 

This is a disease accompanied by great physical and mental ex- 
haustion, consequently the proper regulation of the diet, in order 
to sustain the vitality of the patient, is of the utmost importance. 
Not only during the whole continuance of the fever but during 
convalescence. During all fevers the appetite is very much 
lessened. Milk, soups, broths and various gruels or arrow-root, 
farina, oatmeal, rice and barley flour are customarily given. It is 
the opinion of many, based on the fact that in children who are 
still nursing, complications are of very rare occurrence, that milk 
as an article of diet in scarlet-fever is of the most potent value. 
It is wise therefore to subject the patient to an exclusive milk diet 
during the commencement of the disease. From three to four 
pints every twenty-four hours will comfortably nourish a child 
from three to four years of age, and should be given regularly and 
in measured quantities every two or three hours. 

There are some ready methods of altering the taste of milk 
which may be borne in mind when the child tires of it. Caramel, 
ginger, a little chocolate, cocoa, or very weak tea added to the milk, 
will make the diet less monotonous. If difficulty is experienced by 
the stomach in handling milk, skimming or boiling it will render it 
more digestible. The flat taste of boiled milk can be remove'd by 
the aerating process, pouring it back and forth from one glass to 
another several times, or by adding any charged water. Dilution 
with plain water, one part to two or three of milk, renders diges- 
tion easier; or lime water, three or four tablespoonfuls or more 
to the glass of milk ; or Vichy, bottled plain soda, or Apollinaris 
may be added to the milk in any desired proportion. There are also 
modifications whereby milk may be smuggled in under disguise, 
such as koumiss, junket, whey and buttermilk. 

After the few days of rise of temperature in scarlet fever, the 
appetite generally returns, and the mistake is common of permit- 
ting at this time full diet. It is just at this very period that kidney 
complications are apt to manifest themselves and that dietetic 
errors are most costly. Although the fever has subsided, the rash 
faded, and the sore throat become a thing of the past, the poison is 



46 MEDICAL AND SURGICAL EMERGENCIES. 

still in the system and the kidneys are still struggling with its 
elimination. If the desires of the patient are now allowed full 
sway, quick revenge may be expected at the hands of the laboring 
kidneys. Milk should still be the staple article of diet, though 
rice pudding, milk toast, cream toast, corn starch, wine jelly, 
farina, oatmeal and cream, mush and milk, crackers and milk, 
baked apples, stewed prunes, and oranges may be put upon the 
bill of fare. Stock soups, eggs and meat broths are safer out of 
the diet until after the fourth week. 

Individual cases may demand a strong beef tea or chicken broth, 
at an earlier period, but as a rule the animal extracts are not per- 
missible until the beginning of the second month. Substances 
from the meat are dissolved in them which may irritate the kid- 
neys, and do as much harm as the meat itself. With the comple- 
tion of desquamation, about the twenty-eighth day, soups and 
vegetables are permitted, and a little later a gradual resumption 
of animal fare, beginning with fish. Oysters, chickens and eggs 
should follow in order at two or three days interval before meat 
in moderation is ventured upon. 

DRINKS. 

The beverages of scarlet fever are quite varied, alcoholic drinks, 
coffee and tea being almost the only proscribed fluids. For the 
thirst during the fever stage, water, seltzer, Apollinaris, barley 
water, orange juice in Vichy, and soda lemonade may be used 
freely. A little vanilla ice cream is harmless, and very grateful 
and cooling to the dry and parched throat. After the subsidence 
of the fever, it is well to encourage free use of plain water or the 
alkaline mineral waters throughout the convalescent period, as 
they seem to aid the kidneys in their work of elimination. 

MEDICAL TREATMENT OE SCARLET EEVER. 

This is a disease which cannot be aborted, but if left to itself its 
natural course tends to recovery, if the fever and local symp- 
toms remain within certain bounds. It has certain stages to pass 
through and one cannot safely interfere with its regular course. 
To stand by and watch and, so far as possible, to guard against 
complications are the chief duties of the physician and nurse. All 



MEDICAL AND SURGICAL EMERGENCIES. 47 

details are important as herein indicated and should be carried out 
with religious diligence. As soon as the period of desquamation 
has been reached the patient should have a warm bath once or 
twice during the day. The surface of the body should be washed 
with carbolized soap. The baths hasten the process of desquama- 
tion and in bringing about a healthy condition of the skin. They 
also assist in relieving the congestion of the kidneys. 

An excellent preparation to be given when the patient is nervous 
and the circulation poor and accompanied by drowsiness : carbon- 
ate of ammonia, citrate of iron and ammonia, one and one-half 
drachms ; simple syrup four ounces. One teaspoonful is to be 
given every second or third hour to a child from four to ten years 
of age. Diuretics should be given in order to increase the elimi- 
nating powers of the kidneys. A combination of the following: 
Acetate of potassium, one-half ounce; tincture of digitalis, one 
drachm; simple syrup added enough to make a four ounce mix- 
ture. A teaspoonful dose of the above should be given four times 
per day to a child from five to ten years old. 

When the temperature is running high, pulse rapid and great 
restlessness and depression, small doses of quinine, one grain to 
a child five years of age, every two hours is a good treatment and 
for a hot, burning condition of the skin, a sponge bath of cool 
water every few hours as the condition of the patient would seem 
to indicate. 

By intelligent observation the disease, in the majority of in- 
stances, can be detected early, and proper precautions may be 
taken, looking toward isolation and prevention of the spread of 
this disease ; and many lives will be saved and many cases of this 
disease prevented. 

MEASLES. 

This is a disease in the majority of instances, peculiar to child- 
hood, but it may occur at any age. Few persons escape it at some 
period of their life. It is less liable to occur in young infants than 
in children after dentition, and a second attack is of rare occur- 
rence. It may prevail as an epidemic but it occurs frequently in 
different localities, the number of cases not being enough to class 
it as always epidemic. 



48 MEDICAL AND SURGICAL EMERGENCIES. 

THE CAUSE OF MEASLES. 

It is a contagious disease and, so far as we know at the present 
time, it is only spread by contagion. The poison of measles is 
located either in the secretions from the nose and throat, or it is 
exhaled or given off from the body of the sick one, and so con- 
taminating the air about the sick-room that when persons who 
have not had the disease are brought into contact the disease is 
developed. It has been proved that the blood and mucus secre- 
tions escape from the nose, and often the tears have the power to 
spread the disease by inoculation ; however, there is little question 
but that the disease can be conveyed in clothing and that it is a 
portable disease, capable of being carried around by individuals. 
The exact nature of the poison of measles is not known. 

The average period from the time a person is exposed to the 
poison of measles until the person is affected is about eight days. 
Persons are susceptible to this disease the same as to the other con- 
tagious diseases. The time in which the poison is most active, 
that is, most liable to infect the healthy, is not definitely determined, 
but there is abundant evidence to show that it may be spread 
throughout its entire course. 

THE SYMPTOMS OF MEASLES. 

From eight to ten days after exposure the patient begins to 
suffer from a discharge from the nose, feels tired, languid, chilly 
and irritable. Occasionally convulsions occur in the beginning 
among children. There may or may not be fever in the beginning, 
but very soon after the above symptoms are manifested 
there will be a marked increase in the temperature of the body. 
The eyes will be injected and watered; aversion to bright light. 
The eyelids will be red, more or less swollen ; a constant irritating 
discharge from the nose, with sneezing; pain in the head above 
the brows. There will be more or less sore throat ; voice will be 
husky; also a hoarse cough. The respiration will be hurried. 
There will be a sense of uneasiness and lightness across the chest, 
which will indicate a congestion of the bronchial tubes. After 
these early symptoms have continued, perhaps for twenty- four 
hours, the fever will develop. These catarrhal symptoms will 



MEDICAL AND SURGICAL EMERGENCIES. 49 

continue from forty-eight hours to four days, then the eruption 
makes its appearance. 

ERUPTION STAGE. 

The eruption is first seen upon the face, about the chin, fore- 
head, mouth and side of the nose; then upon the neck; then it 
passes down upon the chest and over the lower part of the body, 
including the legs, and lastly upon the back and hands. The 
eruption upon the face feels like small shot early in the disease. 
Usually it is about four days from the time of the appearance of 
the eruption upon the face before it has passed over the entire 
body, and it begins to fade from that part about thirty-six hours 
after its appearance on that part, that is, it begins to fade from 
the face, then the neck and chest, and finally the back and hands. 
The odor is peculiar during this period. With the appearance of. 
the eruption there is more or less swelling of the surface with 
itching and burning. The color of the eruption will vary from a 
bright rose red to a dark mahogany hue. This difference in color 
depends upon the condition of the individual and the peculiarity 
of the type of the disease, rather than upon the change in the skin 
itself. Convulsions may in children be fatal. Blood from the nose 
is common. An increase of fever and rise of pulse and delirium 
at night often follow the first outburst of the eruption. 

COMPLICATIONS. 

One of the most important complications is bronchitis. Rarely 
is there a case of measles without more or less catarrh of the 
bronchial tubes, however, this complication is not serious unless 
the inflammation of the bronchial tubes passes down into the lungs. 
When it does the patient is in great danger. Pneumonia is also 
a serious complication. Inflammation of the brain occasionally is 
a complication. Inflammation of the ear is of frequent occurrence, 
especially in those who have some hereditary taint in their blood, 
such as scrofula or tuberculosis. 

TREATMENT OF MEASLES. 

In all cases of measles without any complications or irregularity 
in the development of the disease the outcome is nearly always 
4 



50 MEDICAL AND SURGICAL EMERGENCIES. 

favorable. The younger the child the danger is less. The chief 
duty to be performed by those in attendance upon cases of measles 
is to guard the patient against lung and other complications. The 
patient should be placed in a large, well-ventilated, darkened room, 
with a temperature of about sixty-five degrees. The darkened 
room is necessary on account of the congested condition of the 
eyelids. The chief article of diet should be milk. 

care of the: eyes in measles. 

If the patient complains of itching and burning of the surface 
of the body, it is well to sponge with warm water. This has a 
tendency to allay the itching and burning, and also to reduce the 
temperature. In an ordinary case this is all that will be necessary. 
Hot drinks or stimulants of any kind have been used extensively 
upon the supposition that they have power to hasten the appear- 
ance of the eruption, but it is doubtful if they are efficacious in that 
direction, and indeed they have been known to be followed by 
dangerous results ; bringing on convulsions in which death may oc- 
cur. Indeed, some of the very best authorities state emphatically 
that in an ordinary case stimulants should never be given during 
the initiatory period of the fever, unless there is some special indi- 
cation for their use, such as a feeble pulse and great prostration ; 
then they may be used with benefit. The greatest cleanliness should 
be observed, besides there should be free ventilation, avoiding all 
drafts in the sick-room. If there is thirst, cold water may be 
taken in small quantities at a time. It is the duty of those in at- 
tendance to watch closely for the occurrence of lung complications. 
The chest should be frequently examined. The inhalations of 
steam have afforded great relief in those cases where bronchitis 
is severe. The value of vapor inhalations in the treatment of this 
complication in measles is very great; even when pneumonia has 
developed the inhalations are of benefit. There is not so much 
danger from the use of stimulants after the eruption is fully estab- 
lished, and, indeed, when passing off and the fever declining, it is 
often useful, when given in proper quantities. 

There is perhaps nothing better when the little patient is rest- 
less, the fever running high and the eruption slow in making its 
appearance, than a small amount of opium, given in the form of 



MEDICAL AND SURGICAL EMERGENCIES. 51 

Dover's Powders ; one-half grain may be given for every year the 
child is old ; if the child is five years of age from two to two and 
one-half grains may be given with safety and with marked benefit. 
The principal object to be remembered is to prevent complications 
of any kind, when the disease will run through its course and the 
child entirely recover, without any results which would have a 
tendency to deplete the constitution in the future. 

If the cough is severe, a mixture of the following is of benefit : 

Carbonate of ammonia, 15 grains. 
Muriate of ammonia, 15 grains. 
Paregoric, 2\ drachms. 
Simple syrup, enough to make 2 ounces. 

One-half teaspoonful given every two hours to a child from four 
to ten years of age. 

WHOOPING COUGH. 

Whooping cough is an acute, contagious disease, attended by 
a peculiar, characteristic, spasmodic cough. It is a disease of 
childhood, but cases occur in adults. It attacks an individual but 
once. 

SYMPTOMS. 

It has three well recognized stages. The first stage is the stage 
of catarrhal symptoms, in which there is a catarrhal condition of 
the nose and throat, similar to that which is seen in a common cold 
in children. The duration of this stage is from two days to three 
weeks, the average being ten days. The second stage, or spas- 
modic stage, is attended by a characteristic, spasmodic cough. 
This cough is very severe and distressing; the face grows red 
and then begins a long, clear, piping sound, followed by a series 
of rapid, convulsive and forcible expiratory puffs, which are suc- 
ceeded by a prolonged, shrill sound or whoop. If these fits last 
any length of time the cough becomes inaudible and a consider- 
able quantity of clear, sticky mucus is expectorated or vomited 
with the contents of the stomach. During the paroxysm the 
patient grows red or purple in the face. The eyes protrude and 
the tongue assumes a dark appearance, and the little sufferer 
seems on the verge of suffocation. Bleeding from the nose, mouth, 
ears and lungs often occurs during a violent paroxysm of cough- 



52 MEDICAL AND SURGICAL, EMERGENCIES. 

ing. The face becomes puffy. Ulcers may form on the tongue. 
The eyelids may become injected. After spasms of coughing a 
period of exhaustion follows, with soreness of the muscles of the 
chest. The frequency and duration of the coughing spasms varies 
greatly in different cases; there may be one hundred in twenty- 
four hours. They are most frequent at night and, as a rule, the 
severer the paroxysms of coughing the oftener they occur. The 
disease usually attains its height by the end of the fourth or fifth 
week. In mild cases the patient is well in the intervals between 
the paroxysms of coughing, but in severe cases there may be 
weakness and debility, loss of appetite, headache, and more or less 
fever between the paroxysms. 

The third stage, or stage of decline. This stage is not ushered 
in by any well-marked symptoms, but by a great diminution in the 
severity and frequency of the paroxysms. The peculiar whoop 
ceases ; the cough and expectorations are less difficult ; the latter 
becomes more purulent in character and finally, after a period of 
about nine weeks, the characteristic cough ceases altogether and 
the little patient passes into rapid convalesence. 

SOME COMPLICATIONS. 

During the course of the disease, whenever the coughing fits 
lose their characteristic features, namely, the whoop, and become 
dry and hacking, accompanied by great difficulty in breathing, 
this continuing through the intervals between the coughing, and 
spasms with a marked rise in temperature, it indicates compli- 
cations of the lungs. Another complication which is particularly 
to be feared in this disease is congestion of the brain ; when, during 
a paroxysm, the countenance becomes flushed and swollen, the 
jugular veins turgid, with a gush of blood from the nose there is 
danger of such an occurrence. When the face is continually 
flushed, the head hot, the patient drowsy, or restless in his sleep, 
moaning and grinding his teeth, there is danger of convulsions 
and loss of consciousness, in which case the disease often termi- 
nates fatally. 

HOW TO RECOGNIZE WHOOPING COUGH. 

In the earlier stages it is not possible to recognize whooping 
cough with certainty, but its existence may be suspected if the 



MEDICAL AND SURGICAL EMERGENCIES. 53 

cough is of a violent, spasmodic character and if the disease is 
prevalent in the community. When once the disease is established, 
the peculiar cough and the watery expectoration distinguish it 
from other diseases of childhood. 

THE NATURE OE WHOOPING COUGH, AND HOW IT IS SPREAD. 

The contagiousness of the disease becomes evident when a great 
number of cases follow from direct contact with persons affected. 
This has happened so often in this disease that the contagiousness 
is established beyond doubt. The majority of reputable physi- 
cians have expressed themselves emphatically that genuine cases 
of whooping cough attack children but once, although there are 
a few who claim to have observed this disease twice in the same 
person. It rarely, however, attacks adults, and then chiefly among 
the wealthy who have always been separated from their children 
and have thus escaped infection. Nevertheless, parents of chil- 
dren with whooping cough and the nursing maid frequently suf- 
fer from a milder form of spasmodic coughing which seems to be 
due to their being with the patient. Infants, before the commence- 
ment of dentition, are less susceptible than those several months 
older; still there are exceptional cases in which it has occurred 
even before dentition. 

It is not possible to state definitely the exact nature of the con- 
tagious principle, but it is most probably found in the particles of 
mucus expectorated, which, becoming dry, are diffused in the 
surrounding atmosphere and is then in a condition to be inhaled 
during inspiration. 

TREATMENT AND HOW TO PREVENT ITS SPREAD. 

How to prevent its spread consists entirely in the removal of the 
child from the place in which whooping cough is just appearing, 
but perfect separation in this disease is carried out with difficulty. 
Whenever possible an entire change of place is desirable. The 
chief indications in the treatment of whooping cough are : first, to 
diminish the severity of the paroxysms ; second, to prevent and 
treat, so far as possible, the complications, if any exist ; third, to 
attend to the general health and physical condition of the patient. 
There are no known means by which this infection can be re- 



54 MEDICAL AND SURGICAL EMERGENCIES. 

moved; the paroxysms cannot be altogether prevented, but their 
severity may be lessened. 

Of all the internal remedies used they are of doubtful import- 
ance. There is no remedy that will prevent the cough and spasms 
entirely. Of all the remedies used the best that can be accom- 
plished with any of them is to alleviate the severity of the cough 
and spasm, and for this the following remedy has been found use- 
ful; to a child from four to ten years of age the following pre- 
scription may be given in one-half teaspoon ful doses, every two 
hours : 

Chloral hydrate, 40 grains. 

Elexir valerinate of ammonia, 4 drachms. 

Simple syrup, enough to make a two ounce mixture. 

The following prescription has been used extensively by the 
Germans : 

Quinine, 4 parts. 

Dilute sulphuric acid, 2 parts. 

Water, 200 parts. 

A small glass syringe is filled with this solution and ejected 
against the back part of the throat, the mouth being held open and 
the tongue depressed. Some of this is swallowed or spit out. This 
may be done every two or three hours during the first three or four 
days, when marked improvement has followed in many cases. 
Another favorite remedy, used also by the German physicians, is 
the following prescription: Muriate of quinine, 3 parts, rubbed 
with gum acacia, one part. This makes a fine powder, and about 
three grains, or what you can hold on the point of an ordinary 
jack-knife, is blown up into the nostrils or snuffed up by the 
patient, if possible, once or twice in twenty-four hours. This has 
also been followed by marked improvement in many cases. 

The Italian physicians use the following with good results: 

Quinine, pure, 3 parts, 
Benzoic acid, 1 part. 

This is also made into a powder and snuffed up into the nostrils. 



MEDICAL AND SURGICAL EMERGENCIES. 55 

Eight cases reported by Italian physicians by this treatment were 
relieved and cut short very much in their course. 

During the third stage, or stage of convalescence, tonics of iron, 
quinine and cod liver oil are indicated, with a good nourishing 
diet ; plenty of milk in some form, either taken in its natural state, 
or prepared for digestion after the formula given in the chapter 
on the preparation of foods. Onion syrup, honey, and many other 
domestic remedies have been extensively employed, but they act by 
nauseating the patient and produce vomiting, and have no direct 
influence over the course of the disease. 

kinds o£ CROUP. 

There are two kinds of croup; one is a very serious disease 
which is accompanied by a membrane on the throat, resembling 
diphtheria. This false membrane may exist in a few patches, spot- 
ted here and there and of a whitish color over the wind-pipe and 
throat. There is often congestion and swelling of the parts also. 
The other form, which is known as false croup, is an entirely 
different disease and is the form in which it is met generally 
among children, and is very much dreaded by the laity. False 
croup is a simple catarrh of the throat and wind-pipe, is spasmodic, 
and it is the spasmodic condition of the wind-pipe which gives 
rise to the croupy symptoms which are more or less familiar to 
every mother's ears, and if once heard will never be forgotten. In. 
this form the croupy symptoms come on quite suddenly and 
the attack usually occurs at night. It may not be preceded or 
accompanied by any fever; there is no complete loss of voice, 
and there is an absence of any membrane on the throat and 
tonsils. 

There are various causes which are attributed to give rise to 
this form of croup; among these are irritation of the teeth and 
stomach, enlargement of the glands of the throat, and an undue 
excitability of the nervous system, the latter often occurring at 
the result of hereditary predisposition. The suddenness of the 
attack is almost characteristic of this disease. The child may 
go to bed feeling entirely well, and during the night arouse the 
anxious parents by the croupy cough and difficulty in breathing, so 
severe is the latter in many cases that life seems in imminent 
danger. 



56 MEDICAL AND SURGICAL EMERGENCIES. 

This is a common disease and ordinarily occurs between the 
ages of two to five years. Some children in the same family 
are more liable to croup than others. It is not uncommon in 
the commencement of measles. Exposure to cold is often the 
exciting cause. The sleep preceding the attack may be quiet 
and natural, but when the child awakes there is a loud barking 
cough and the respirations may be harsh and whistling. The 
face is flushed and indicates great suffering. The child cries, 
goes from one position to another, wishes to be held or carried, 
seeking in vain for relief, the skin is hot and dry, and the pulse 
hurried. These symptoms continue usually from one-half hour 
to two or three. They should not last for over a half hour with 
proper treatment. When the little patient is relieved, exhaustion 
and sleep follow. The cough, though less frequent, remains for 
a time of a barking character and the respirations are not natural 
for some time, but they gradually become so. Often there is 
no return of the spasmodic symptoms but quite frequently an 
attack occurs at about the same time the following night. The 
termination is not always favorable ; it is often followed by other 
serious effects, which may prove fatal ; bronchitis often sets in or 
pneumonia. 

TREATMENT. 

The first indication to be followed is to relieve the spasms, 
and to do this a warm bath is indicated, at a temperature of 
about ioo degrees, or as warm as the child can reasonably and 
safely be kept in without scalding, and should be kept in it for 
ten or fifteen minutes in order to obtain its full relaxing effect. 
In mild cases a warm foot-bath may be sufficient. An emetic 
should be given at the same time as the bath. To children under 
three years of age there are many remedies which every household 
having children should keep on hand. They are simple, inex- 
pensive and not dangerous, and can be employed with great benefit 
and relief before a physician's services can be secured. 

The following remedies are very useful and very effective : a 
teaspoonful of powdered alum, mixed with honey or syrup. A 
small amount of this can be given every half hour until vomiting 
occurs. Another remedy which is equal to, if not better than, 
the above is the Compound Syrup of Squills, about a teaspoonful 



MEDICAL AND SURGICAL EMERGENCIES. 57 

together with a teaspoonful of the Syrup of Ipecac. Generally 
one dose of the above will be sufficient to produce vomiting, if 
not another dose can be given, but it is scarcely ever necessary 
to give more than two or three doses. 

A warm bath and some of the above remedies should be given 
immediately when the croupy symptoms are present, when marked 
relief will generally follow if there are no complications. I have 
found also the inhalation of steam from hot water to be very 
useful. An old tea-pot or tea-kettle in which water can be 
heated and the steam allowed to escape in close proximity to 
the child's mouth and nose, and the child encouraged to inhale 
as much of it as possible. Mustard plasters applied to the throat 
and upper part of the chest are also very useful. 

Another domestic remedy which has proved to be of great 
value is onions, a poultice of onions placed in a cloth as warm as 
can be borne and applied to the throat of the little patient. 

All that is necessary is to have these remedies at hand and use 
them promptly and in an intelligent manner. 

After the immediate symptoms are relieved there generally 
follows a cough, which needs some treatment. The Syrup of 
Ipecac or the Syrup of Squills can be given every three hours, 
in from ten to twenty drop doses to a child aged five years. A 
mild laxative should also be given after the spasmodic symptoms 
have been relieved, and for this purpose there is probably nothing 
better than the Syrup of Cascara Cordial which is a harmless and 
very useful remedy, and is very extensively used among children 
and prescribed generally by the medical profession. 

The patient should be kept in a warm room for several days; 
the atmosphere should be moist. A general tonic should follow 
and the strength of the patient kept up by good nourishment. 

CHICKEN POX OR VARICELLA. 

Chicken pox is the mildest of the fevers accompanied by 
an eruption. It is very contagious, so that few children escape 
who have been exposed to it. The period from exposure to the 
breaking out of the disease is from fifteen to seventeen days. It 
is a disease of child-hood but also occurs in adults. It usually 
commences with a fever, chill, head-ache, sometimes aching in 
the back and limbs, and the pulse increases to 100 or 112. 



58 MEDICAL AND SURGICAL EMERGENCIES. 

When the above symptoms have continued for about twenty- 
four hours the eruption appears on the trunk of the body and 
soon afterwards over the face and limbs. The only other disease 
with which it is liable to be confounded is small pox. 

TREATMENT. 

Rest in bed, cleanliness, nourishing diet and warm drinks, and 
with no complications, nothing further in the line of treatment 
is indicated. (See P. at end of book.) 

CHOLERA INFANTUM. 

This is what is commonly understood as the summer diarrhea 
of children. This is a disease which is to be greatly dreaded, 
in cities especially, where the mortality is extremely large. Among 
the principal causes heat may be enumerated. It is most prev- 
alent during the months of July and August, although cases 
occur from May to October ; a residence in an atmosphere loaded 
with noxious vapors, where gases rise from the decomposition 
of animal and vegetable matter, or the atmosphere is rendered im- 
pure by overcrowding and by personal and domestic uncleanliness. 
It is therefore more commonly found in tenement houses and 
parts of the city occupied by the poorer class of people, where 
there is less attention paid to cleanliness in general, and where 
it is impossible to secure a proper amount of fresh air. So long 
as the temperature is moderate the diarrhea will, in all probability, 
be simple in form, but, should the temperature rise from 85 
degrees to 95 degrees Eahr. or even higher, and remain there for 
several days, as happens occasionally in our summer months, the 
form of diarrhea will immediately become much more severe 
and will be very liable to take the inflammatory form. 

SOME CAUSES OF CHOLERA INFANTUM. 

The next cause of importance is improper diet. Sudden weaning 

of the child from a natural food to an artificial ought to be 

avoided during the summer months. Unwholesome milk of any 

kind or the use of vegetables, unripe or unhealthy fruits, such 

,as apples, currants, gooseberries or blackberries will sometimes 



MEDICAL AND SURGICAL EMERGENCIES. 59 

bring on in a very few hours the most violent attacks of Cholera 
Infantum or change a comparatively mild and safe attack into 
a more violent and fatal form. Among the causes in cities, where 
epidemics have existed, the following conditions have been known 
to exist : 

1. Decaying organic matters, bone, hide, fat and offal houses, 
neglected stables, putrescent mud and filth. 

2. Bad drainage, local dampness, malaria. 

3. Obstructed sewers, filthy streets, gutters, stables, garbage 
and cesspools. 

4. Water and beverages in any manner contaminated by 
putrescent organic matter, particularly by any soakage from 
privies. 

5. Neglected privies and putrefying excrement. 

6. Overcrowding and neglect of ventilation. 

It is just where these conditions are most rife that choleraic 
diseases in children are most apt to occur. Amongst the poor, 
who inhabit the crowded quarters of cities, where the streets and 
alleys are small and narrow, where heaps of decaying vegetable 
and organic matter abound, where water is scant, or scantily 
used, where ventilation, from the manner in which the streets 
are laid out, and from the crowding together of buildings, is 
necessarily imperfect, we have the most numerous and severest 
forms of the disease. It is amongst the poor, too, that the food 
is often of necessity, as well as from ignorance and recklessness, 
of the most improper kind, and not infrequently insufficient in 
quantity. 

Age, sex, dentition, constitution and hereditary predisposition 
are all powerful factors in the causation of this disease. Statistics 
show that there are about twice as many fatal cases among chil- 
dren during the first year than in the second, although dentition is 
certainly more active and continuous during the second year than 
in the first; however, cases are rarely observed before the begin- 
ning of teething and the disease is certainly very rare after teething 
is completed. 

SYMPTOMS. 

Cholera Infantum is known as such when it occurs under five 
years of age ; after this date it is known as Cholera Morbus. The 



60 MEDICAL AND SURGICAL EMERGENCIES. 

former sometimes commences abruptly, previous health of child 
having been good, in other cases there may have been a previous 
mild diarrhea. The stools become thinner than natural and some- 
what more frequent. Suddenly the evacuation becomes more 
frequent and watery, and the parents are surprised and frightened 
by the rapid sinking and real danger of the infant. Accompany- 
ing this condition is another symptom, namely, irritability of the 
stomach, vomiting, nausea, and retching without vomiting. The 
appetite is less and the thirst is intense ; cold water is craved for 
and taken with avidity; and, if the infant nurses, it eagerly 
seizes the breast in order to relieve the thirst; the tongue is 
moist, at first clean but it may be covered with a light fur. The 
temperature is elevated ; there is no disease of infancy in which 
the temperature of the blood rises higher, it may rise as high 
as 105 degrees, or even higher. The disease may approach a 
fatal termination in two or three days ; the limbs and cheeks 
become cool, the eyes blurred ; pupils contracted ; the urine scanty 
and suppressed. The pulse becomes more feeble and the surface 
clammy and cold; and stupor results. 

TREATMENT. 

Preventive treatment. The danger to which teething children 
are exposed from living in cities during the hot months of the 
year are now so well understood that most families remove to the 
country during the warm season and, by so doing, generally 
avoid the disease. This is undoubtedly the best plan to follow 
by those raising children in cities, however, when this cannot be 
done, the preventive treatment consists in the most careful atten- 
tion to diet, dress, thorough ventilation of the living rooms, and 
exposure to the open air. If the child is nursing it should be 
kept at the breast until it has passed through the second summer, 
as there is little danger from this disease after that period. If, for 
any cause, weaning must take place prior to that date it ought 
to be done before the hot weather begins. If the child is weaned 
the diet must be strictly attended to. Up to the age of ten months 
or a year, the food should consist almost wholly of milk contain- 
ing arrow-root, rice, oatmeal or some farinaceous substance in 
small quantity. A little plain chicken or mutton water, with rice 



MEDICAL AND SURGICAL EMERGENCIES. 61 

boiled in it, or a piece of beef or chicken to suck may be given 
occasionally, but all vegetables and fruit should be strictly for- 
bidden. After the age of ten months, some light soup and small 
portions of mutton, chicken or very tender beef, minced very 
fine, may be given every day in addition to the milk food, which 
must still form the larger part of the child's diet. For further 
information on how to prepare these different forms of diet, we 

The dress should be arranged according to the heat of the day. 
refer the reader to the article on food in another part of this work. 
"We have not rarely known young children to be kept clothed all 
summer in thick flannel jackets, and petticoats and woolen socks. 
This is certainly wrong and too much for the heat which fre- 
quently occurs during the months of July and August and part 
of September, and is, we believe, very injurious. A light gauze 
flannel shirt is the only woolen garment that need be worn during 
the warm season. On hot days, a child should have only this, 
a muslin petticoat and frock and the lightest possible stockings, 
or none at all. If, as constantly happens in our climate, a cool 
day comes, there should be added a light flannel petticoat. 

It is important that the child should pass a large part of the 
day in the open air. We believe that, with a constant and wise 
attention to these points, namely, diet, dress, careful ventilation 
of house and bed room, exposure to the air, and exercise, much 
may be done towards preventing this disease, even if families 
are obliged to remain in the city during the summer. 

After the disease is once established something can be done by 
way of reducing the number of discharges, and also toward 
making the little patient more comfortable. The following pre- 
scription has had an extensive use among the leading physicians 
of New York city : 

Tincture of opium, 15 drops. 

Aromatic spirits of ammonia, -J drachm to I drachm. 

Subnitrate of bismuth, 2 drachms. 

Chalk mixture, i-J ounces. 

Simple syrup, \ ounce. 

An infant six months old should take about twenty drops every 
two hours ; and for a child one year old one-half a teaspoonful. 



62 MEDICAL AND SURGICAL EMERGENCIES. 

When the skin is hot and the fever high, frequent sponging of 
the surface of the body with tepid water and alcohol has been 
found very grateful. 

Lime water and milk may also be given in the following 
amounts: Take two parts of milk with one of lime water, and 
add fifty per cent, water which has previously been boiled. A 
teaspoonful or two of this can be given every hour, when the little 
patient craves for something to drink. 

When the patient begins to improve, and when there is danger 
of taking food which will prolong the disease or cause a relapse, 
I have found the following very useful: equal parts of milk, 
cream, lime water and plain water can be given with comparative 
safety. Medicines, as a rule in this disease, have not yielded the 
best results; there is more to be accomplished by nursing, and 
proper diet, but this must be done intelligently, and the food be 
properly prepared and given in proper amounts. If this is not 
done, all remedies directed toward the relief of this disease will do 
very little good. (See prescription for same.) 

MUMPS OR PAROTIDITIS. 

In the human being there are located two glands, in front of 
and towards the lower side. of the ear, one on each side of the 
head, glands known as the parotids. Connected with this gland 
on the inside of the mouth and opening upon the molar teeth on 
each side, is a little tube about the size of a goose quill. During 
the mastication of our food, when it is being rolled around under 
the teeth, this gland gives out a fluid, which is carried and poured 
out on the food while under the teeth, by this little tube, which 
reaches up to the gland on either side. This is what is known as 
the saliva, or what is more commonly understood among the laity 
as the spittle. It performs a very important function in digestion 
by lubricating the different varieties of food and assisting in the 
first process of digestion. 

It is this parotid gland which becomes diseased when an indi- 
vidual has the mumps. This gland becomes tender and enlarged, 
the swelling gradually increases until the depression under the 
ear is filled, and the swelling may extend upwards and forwards 
upon the cheek, or downwards to a greater or less extent upon the 



MEDICAL AND SURGICAL EMERGENCIES. 63 

neck. This inflamed or swollen condition of the gland is said to 
be due to a specific poison in the blood. 

The swelling reaches its full extent on from the third to the 
sixth day. The most prominent point in the swelling is generally 
underneath the ear. Movements of the jaw during mastication, 
and even talking, causes considerable pain. Fever is also present, 
but ordinarily does not last more than forty-eight hours. The 
swelling, when it has reached its full extent, remains so for a 
short time, when it begins to decline, and by the sixth or tenth 
day it has entirely disappeared. The total duration of the disease 
is usually from eight to ten days ; in mild cases it may not be more 
than five. 

The swelling of the glands sometimes abates suddenly; and in 
the male the testicles may become involved; while in the female 
the mammary glands or ovaries become affected. Young children 
or old people do not often take the mumps. 

Mumps are contagious, and the period from exposure until the 
person comes down with the disease is about twelve days. 

TREATMENT OF MUMPS. 

It is very simple. Anything soothing applied over the swelling 
will give relief. Mild laxatives, and warm drinks, such as lemon- 
ade, should be given, while the patient should be kept warm. A 
poultice of hot hops is also an excellent remedy. A mild diet, 
such as poached eggs and milk with a little beef soup, according 
to the formula given before, is all that is necessary. (Prescrip- 
tion for mumps will be found under above title.) 

ST. VITUS'S DANCE OR CHOREA. 

This is a disease of the nervous system marked by muscular 
twitchings. It is most frequently met with between the ages of 
six and sixteen. It is liable to follow any child whose parents 
have suffered from hysteria, epilepsy or other forms of nervous 
diseases. From two-thirds to three-fourths of all cases of St. 
Vitus's Dance occur in young girls. Feebleness of constitution, 
and the injurious system of forcing the education of children pre- 
disposes to chorea. The most common predisposing cause is un- 
doubtedly anemic condition of the system. There is generally 



64 MEDICAL AND SURGICAL EMERGENCIES. 

an enfeebled condition present, with a deficiency in the richness 
of the blood. In many children with an hereditary tendency to 
nervousness a very slight cause will often bring on an attack. 
A not infrequent cause is fright, and a sudden excitation of the 
nervous system. 

SYMPTOMS. 

The muscular twitchings may be confined to one arm, or side 
of face or neck, or of one eye, or it may be general, when all the 
limbs and muscles of the face and body are involved. Statistics 
show that the left more than the right side is involved. 

COURSE OF THE DISEASE. 

Although the disease is obstinate, and even often incurable in 
adults, it usually terminates favorably in children in three or four 
months. Very often the first indication of the disease will be a 
restlessness; sometimes there will be a twitching of the fingers, 
and involuntary movements in walking, one will stumble, and they 
will often find great difficulty in putting food in the mouth. In 
a mild case in a child the patient will seem awkward; will break 
<lishes involuntarily; the speech may become affected; and pain 
will be complained of on the affected side. 

TREATMENT. 

In all cases close observation and thorough examination should 
foe made in order to discover the cause. Investigation should be 
made as to whether intestinal worms are present, or constipation, 
if either is found they should be properly treated and removed. 
In all cases mental and bodily rest must be insisted upon. A 
generous and hearty diet, and pleasant surroundings should be 
obtained; when patient lives in the city, if possible, a change of 
air and surroundings to the country is advisable. Children with 
St. Vitus's Dance should not go to school. 

There is one drug that has given better results than probably 
any other in the treatment of this disease, namely, arsenic, in 
Fowler's Solution. Begin with three drops in water after eating, 
increasing one drop every day until eight drops is reached, and 
then one drop less every day should be given until three drops is 



MEDICAL AND SURGICAL EMERGENCIES. 65 

reached as in the beginning, when the upward course may be 
again followed. This is the treatment for a child from five to ten 
years of age, either sex. 

Electricity and friction should also be employed. A very use- 
ful remedy which can be applied at home is salt and water, a 
cupful of salt to one-half gallon of water, and the surface of 
the body rubbed with a crash towel once a day, preferably at 
night. This will stimulate the nervous system and assist in the 
circulation of the blood, also aid in digestion. For a course of 
electricity it will be necessary to consult your physician, and have 
it properly applied. 

With the above remedies, and the carrying out of those indi- 
cations, in the majority of cases, your patient will recover and be 
entirely well. 

DISEASES OF THE EAR IN CHILDREN. 

It was the experience of those in charge of the Manhattan Eye 
and Ear Hospital, New York, that out of three hundred and 
eighty-three cases of diseases of the ear in children under fourteen 
years of age, which had come under their observation, three hun- 
dred and forty-six, or all but thirty-seven of them, the diseases 
were located in the middle ear. The diagnosis of this disease can 
almost be made by the character of the discharge. If the latter 
is foul-smelling and purulent in character, this evidence is suffi- 
cient to locate the disease in the middle ear. In all these cases 
the drum-membrane is ruptured and there is inflammation of the 
surrounding covering of bone, and also of the tube known as the 
Eustachian Tube, which leads from the ear to the throat. 

TREATMENT. 

The treatment should first consist in cleansing the ear, and 
there is nothing better than a hot douche containing a few drops 
of peroxide of hydrogen. After the ear is thoroughly cleansed, 
a powder composed of pulverized borax, one-half drachm, and 
iodoform, five grains, should be used; the powder should be 
thoroughly mixed together and blown in the ear, or a small 
piece of cotton batting may be saturated with the above remedy, 
placed in the ear, and allowed to remain for a short time. If the 
5 



66 MEDICAL AND SURGICAL EMERGENCIES. 

discharge is abundant the hot douche should be used three or 
four times during the day, and the powder used after each cleans- 
ing treatment. 

Very often the disease will continue for a long time, especially 
is this the case if the infant is scrofulous, or has any other blood 
disease. The system must be built up by proper tonics. The 
tincture of iron, five drops, three times a day after eating, for a 
child from five to ten years old, is good treatment; or the syrup 
of hypophosphites, one-half teaspoonful in water or milk, also 
three times a day after eating. When the weather is mild and 
agreeable, out-door exercise should be prescribed, as the sun-light 
and air assists in the assimilation and absorption of food. 



TEETHING— TREATMENT OF. 

Worms in the Alimentary Canal. 

There is prob<vbly no subject of more importance, or of which 
it is more advantageous to the mother to have some knowledge 
than that of teething. During the course of life the human being 
is provided with two sets of teeth ; the first is called the temporary 
or milk teeth, and makes its appearance in infancy, and, in the 
course of a few years, are shed and replaced by the second or 
permanent teeth. 

The temporary or milk teeth are ten in number in each jaw; 
on either side from the middle line there are what is known as 
two incisors, one canine and two molars. 

The number of permanent teeth in each jaw is sixteen: six 
molars, two canines, four incisors, and four bicuspids. 

The time the first or temporary teeth make their appearance is 
varied ; some children may cut their first teeth before the age of 
six months, and others not until nearly the twelfth month, and 
some have been known to have teeth when born. In nearly all. 
cases the two central incisors of the lower jaw are cut first, these 
being followed shortly afterwards by the four incisors of the upper 
jaw; the others follow and the first dentition is completed at 
about the age of two years. These milk teeth are in use from the 
age of two up to five and a half years ; at about this age the first 
permanent molars or back teeth, four in number, begin to make 
their appearance. 

It was formerly the opinion of many of the medical profession 
(and at the present time entertained by the laity), that many 
diseases of childhood were directly or indirectly caused by teeth- 
ing. The teeth developing and coming through the gums is 
commonly attended by more or less congestion and swelling ; this 
is often greater with some teeth than with others, thus, the incisors 
of the upper jaw cause more swelling than those of the lower. 

67 



68 MEDICAL AND SURGICAL EMERGENCIES. 

Some children, previous to the eruption of the teeth, are affected 
with diarrhea, and quite frequently there is an irritable condition 
of the stomach. There are other more serious conditions which 
have been traced to dentition; convulsions, commonly known as 
fits, occur. In these cases a careful examination of the gum gen- 
erally discloses a swollen, congested condition surrounding the 
teeth which are forcing their way to the surface. 

Convulsions are more liable to happen when several teeth pene- 
trate the gum at about the same time. Some medical writers are 
of the opinion that inflammation of the brain results from teeth- 
ing, although the facts have not been forth-coming and it is not 
generally believed at the present time. 

TREATMENT OF TEETHING. 

This will depend upon the actual conditions which exist in each 
and every case. If there is diarrhea, of course, this should be 
treated with proper remedies ; if there are nervous conditions such 
as convulsions, these require soothing remedies. The gums should 
be examined carefully and if found swollen and tender, soothing 
remedies are sometimes useful. The infant should be allowed to 
hold in the mouth an india rubber or ivory ring which, by pressure 
on the gums, often gives great relief. Mothers will often attempt 
to "rub through the teeth," as they term it, by means of a ring 
or finger ; this should not be done ; friction of this kind will have 
an injurious effect by increasing the swelling and inflammation, 
unless the teeth are just about through the membrane. 

There is a considerable difference of opinion in relation to the 
necessity of lancing the gums; it is not now employed so fre- 
quently as formerly. It is thought wise now by eminent specialists 
in the diseases of children not to be in a hurry in using the lance. 
If the infant seems to be in immediate danger, as in convulsions, 
and is not relieved by the ordinary means, lancing the gums is 
not only required but is an absolute necessity. Unless the tooth 
is very near the surface lancing will not give even temporary 
relief, from the fact, borne out by experience, that the congested 
gum will again become united and it will be more difficult for the 
tooth to protrude. 



MEDICAL AND SURGICAL EMERGENCIES. 69 

For a child in convulsions there is probably nothing better than 
the following : 

Bromide of potassium, 1 drachm. 
Tincture of valerian, 4 drachms. 
Water enough to make 2 ounces. 

A teaspoonful of this to a child two years of age should be 
given every two hours; the child must be immediately plunged 
into a warm bath, in which is placed a little mustard, and more 
or less friction made along the spine ; and the child should remain 
in the bath until the convulsion is over. The bromide of potas- 
sium is an excellent remedy to give during the period of teething 
for the nervous condition which frequently exists; it should be 
given in about three grain doses, four times a day, in a little 
syrup, for a child two years of age. 

WORMS IN THE ALIMENTARY CANAL. 

There are four different species of worms found in the aliment- 
ary canal : viz., the round, tape, thread and pin. The round worm 
is in shape not unlike the common earth worm, and varies in 
length generally between six and twelve inches and is usually 
about the thickness of a common penholder ; the color of the worm 
is whitish or yellowish ; the male may be known by its tail which 
is slightly curved while that of the female is shorter and thicker. 
The thread or seat worm is the smallest of the intestinal worms, 
and looks not unlike a piece of cotton thread, from whence its 
name was derived. There is one other variety of thread worm 
which is longer, generally about an inch and a half to two inches 
long; they are found generally midway between the stomach and 
the rectum in the intestinal canal. Tapeworms are rarely found 
in children ; out of two hundred and six cases observed only 
twenty-two occurred in subjects under fifteen years of age. The 
common tapeworm is from seven to thirty feet long; it has a 
head, neck and made up in segments. They are almost exclusively 
found in the upper part of the intestinal canal. 

The frequency of intestinal worms and their importance as the 



70 MEDICAL AND SURGICAL EMERGENCIES. 

cause of disease have certainly been, and are still by many physi- 
cians, and especially by the public, very greatly exaggerated. 
There can be no doubt that, when they exist in large quantities, 
and particularly in certain countries, they give rise to great dis- 
turbances of the digestive system, and even occasion death. But 
such instances are extremely rare in my experience. When we 
consider how universally worms are found in all young animals, 
and how frequently they exist in the human body without pro- 
ducing disease of any kind, it is but to conclude that they serve 
some useful purpose in the animal economy. 

Worms develop in the intestines of the human being by the 
entrance of the egg, which develops into the different varieties 
of the intestinal parasite. Their entrance into the intestinal tract 
is only effected through food and drink. Butchers and those who 
handle raw meat are more subject to them than others; filth and 
personal squalor are factors which favor their development. 

The seat worm when present in small numbers occasions few 
symptoms ; when they are numerous there is intense itching around 
the anus, especially on retiring, when the increased warmth causes 
them to be very active, and by this the sleep is more or less dis- 
turbed. They often cause a frequent desire to go to stool, and 
sometimes there is an abnormal amount of mucus mixed with the 
faeces. 

The prevention of the formation of worms demands that all raw 
or underdone meat should be avoided ; measly pork should not be 
allowed to be sold in the markets, and wells and springs from 
which water may be obtained should be removed from the neigh- 
borhood of stock-yards. 

The means used for the expulsion of the tapeworm have for 
their object the dislodgment of its head; so long as this remains 
it is useless to hope for a cessation of the symptoms. The diet 
should be restricted for two or three days before the administra- 
tion of medicines. Several remedies have been used with more 
or less success; there is probably nothing better than male fern; 
it is one of the oldest and best known remedies ; the extract of the 
oil is given in capsules, those of one-half drachm each should be 
followed by a dose of castor oil, or oil of turpentine in one-half 
or one ounce doses has also been used with very good effect. An 






MEDICAL AND SURGICAL EMERGENCIES. 71 

emulsion of pumpkin seeds frequently acts very efficiently, also the 
active principle of pomegranate root bark. 

The following prescription is a very valuable one, and is used 
extensively by many French physicians : 

Sulphate of pelletierine, 1 ounce. 
Tannin, 15.23 grains. 
Sweetened water, 5 drachms. 

This may be used in all cases except ( 1 ) in individuals of great 
nervous irritability, (2) in pregnancy, (3) in very young chil- 
dren. In order to combat the muscular paresis of the intestines 
due to the action of the pelletierine, a half hour or an hour pre- 
viously there is frequently given an infusion of two and a half 
to four drachms of senna leaves, sweetened with an ounce of syrup 
of bitter orange-peel. The pelletierine prescription should be mixed 
with an equal bulk of water. The patient takes at first half, the 
other half in from ten to thirty minutes, at once, or in separate 
doses. To prevent vomiting he should remain lying down. The 
purgatives should be given half an hour after the last of the pelle- 
tierine. This may consist of German brandy and thirty to fifty 
grammes (gr. 462.97 to gr. yyi.62) of castor oil in capsules or 
emulsion. Evacuations should be made in a vessel half filled with 
water. 

Treatment for round worms is chiefly santonin; a convenient 
form for administration is the troche, or it may be prescribed in 
powder with calomel. The following is the most successful plan 
of dislodging these parasites : 

Santonin, five grains; calomel, five grains, for an adult; one- 
half the amount for a child. When giving this, it should be pre- 
ceded by a laxative in the morning, fasting during the day, and 
the santonin and calomel given at bed-time, followed in the morn- 
ing by a draught of senna. Troches of santonin are made as 
follows : santonin, one-half ounce ; with sugar tragacanth, orange- 
flower water, to form four hundred and eighty troches. Each 
drop contains one-half grain of santonin. 

Treatment for pin, or seat worm : For a child four years old 
an injection of lime water has been found very successful ; it may 
be given with equal quantities of warm milk or flaxseed tea, or 



72 MEDICAL AND SURGICAL EMERGENCIES. 

the following is also useful : one teaspoonful of turpentine to one 
glassful of milk; also the following: carbolic acid, ten drops; 
water, one glassful. Enemata of oak bark, alum and salt water 
has also been found very useful. It is necessary to keep the parts 
scrupulously clean. 

There are other varieties of intestinal worms, but the four 
mentioned, tape, round, pin and thread, are the most common, 
and the above remedies will be found very useful and successful 
in dislodging them. 



ACCIDENTS AND EMERGENCIES. 

What to do in Cases of Accidents and Emergencies — What 
to do in Case of Drowning — How to Produce Artificial 
Respiration. 

some general considerations — what to do and what not to 
do in cases of accidents and emergencies. 

"A little knowledge is a dangerous thing," said an eminent 
author. The danger depends largely upon the possession of this 
knowledge, and how and where the application is made. 

There is no condition of which we can conceive wherein a 
little knowledge will be of more utility than in the presence of 
accidents and emergencies. 

How valuable are the services of the man or woman who hap- 
pens to be present at an accident or injury, who possesses a cool 
head, a strong hand and knowledge enough to know what is the 
best thing to do under the circumstances. Such a one must 
acquire the necessary knowledge before the emergency arises. 
With this end in view we will endeavor, in this and succeeding 
articles, to give simple and practicable illustrations of what should 
be done in certain accidents. 

Such knowledge is not to take the place of sending for a physi- 
cian or surgeon. There are very many cases of injury that require 
immediate attention. From the inception of any injury until 
skilled assistance is secured, in the majority of cases, is very 
valuable time ; time which, if properly utilized by those who may 
chance to be present, may save the life, or at least relieve the 
unfortunate sufferer. 

Some individual, who possesses the coolness, courage and infor- 
mation should immediately assume command and bring order out 
of chaos. Such an one will rarely fail to be recognized by the tim- 
orous and less efficient, and will usually find very little difficulty in 

73 



74 MEDICAL AND SURGICAL EMERGENCIES. 

directing them so they will render some valuable assistance, or 
at least do no harm to the sufferer. 

In this city, Detroit, there are four or five partially eleemosynary 
hospitals with ambulances attached, ready to respond day or 
night, at a moment's notice, to calls in any part of the city. Be- 
tween two and three thousand calls are responded to annually — the 
larger part being serious accidents, requiring immediate assist- 
ance. 

A case : A man walking along the street suddenly falls over ; 
it may be from intoxication, an apoplectic fit, an epileptic fit, heart 
disease, or, if the weather is hot, may have received a sun-stroke. 
A crowd gathers, general consternation and great excitement pre- 
vails. No one is present competent to render proper assistance to 
the sufferer. As happened a short time ago, two boys were playing 
with open pocket knives, when one accidentally struck the shaft 
blade of the knife into the large artery of the other's leg, severing 
it. Before proper assistance could be secured, the loss of blood was 
so great that death followed. 

Another case was that of a man in an intoxicated condition, who 
was accidentally run over by a street car, breaking both legs. The 
shock and loss of blood were so great that he soon became uncon- 
scious. Anxious and sympathetic, but ill-advised bystanders, eager 
to do something toward assisting the poor, unfortunate fellow, 
secured an additional amount of whisky and poured it down his 
throat, blindly thinking to restore him, while the blood was still 
pouring from the lacerated limbs. He was beyond recovery when 
the proper help was secured. 

Any screaming or wailing should be stopped, if possible. Then, 
no more persons than are needed should be called to assist in 
removing the one in danger; or, if he be crushed, to assist in 
removing whatever rests upon the injured part. Next, his body 
should be placed in a comfortable position — lying down, with the 
head a very little raised — after which an investigation may be 
made to find out, as nearly as possible, the nature of the injury, and 
a line of subsequent action immediately decided upon. 

Just as soon as these preliminaries are carried out, or before if 
possible, some one should be dispatched for the doctor, or the 
ambulance, or both, as the severity of the case demands, and cer- 
tainly with proper instructions as to the nature of the injury, in 



MEDICAL AND SURGICAL EMERGENCIES. 75 

order that the physician or ambulance surgeon may have an idea 
of what he may expect to find upon his arrival, so that he can 
bring along the necessary instruments and remedies immediately 
needed for the proper treatment of the injured. 

While awaiting the arrival of the ambulance or of the doctor, 
whatever may be advisable may be done by those at hand according 
to the nature of the injury and the severity of the case. Clothing 
may have to be loosened or perhaps removed. If the case be one 
of fainting or swooning away, efforts which assist in resuscitation 
should at once be practiced. If it is a case of drowning efforts 
should be at once directed toward bringing the unfortunate one to 
a normal condition, including artificial respiration. If the injury 
is a broken leg, temporary splints with bandage may be provided. 
If there is a hemorrhage or bleeding, means should be used to 
control it, as a few minutes of inaction when a large artery is 
severed would likely jeopardize the life of the person. 

In some cases it is very important to know what ought not to be 
done. Large quantities of strong stimulants, whisky or brandy, 
should not be given. If the case be one that seems to need stimu- 
lants, the non-medical bystanders had better stick to water, hot or 
cold, tea, coffee, milk, or the inhalation of spirits of camphor, or 
ammonia, if the individual can breathe. Alcoholic stimulants, as 
a rule, except in very small quantities, are not only unnecessary, 
but positively harmful. They often injure the patient, mislead the 
doctor and interfere with the proper treatment of the case. Excep 1 
tions may be discovered to these general statements, but the above 
is the rule and not the exception. 

Do not do too much. That would make a bad matter worse — 
making bad use of instructions intended to bridge over an interval 
between the occurrence of an accident and the coming of one whose 
whole time is given to healing. The true principle is, when the 
urgency is pressing, to do what is known to be helpful, and when 
one is not sure do nothing. Every physician or surgeon of experi- 
ence can recall instances where a little knowledge of simple reme- 
dies properly applied, would have been of incalculable benefit, and 
others where positive injury was done by meddlesome, venture- 
some and ill-informed persons. 



76 MEDICAL AND SURGICAL EMERGENCIES. 

DROWNING. 

Obstructions to Respiration — How to Revive the Drowning. 

How long a person may be under the water and yet recover is an 
important question, and one upon which there is a diversity of 
opinion, the answer depending upon many considerations. The 
immediate cause of death when a person dies from drowning alone 
is the filling of the air passages with water and shutting out the 
air so necessary to existence. 

Those who are suddenly precipitated into the water, had they the 
presence of mind, or the requisite knowledge, to take one or several 
full breaths at every available opportunity, and retain the air as 
long as possible, thereby decreasing their specific gravity and 
causing their bodies to float more readily, would often live until 
assistance could reach them. The lungs are capable of receiving 
a large quantity of water, and it is this water that causes death 
by drowning. It is retained in the lungs and by its presence pre- 
vents the passing in of air, and finally the circulation of blood and 
the action of the heart stop. 

WHAT TO DO IN CASE OE DROWNING. 

It may seem almost absurd to say that the first thing to be done 
when one has been exposed to drowning is to remove the person 
from the water, yet I well remember having seen some years ago, 
the spectacle of a woman's body, held by a rope, floating in the 
river, and gazed at by hundreds of curious people. Upon inquiry, 
a policeman gravely informed me that no one dared to take it out 
until the arrival of the coroner. This is a mistake. Any one who 
thinks there is a chance of resuscitation should remove from the 
water a person presumed to have been drowned, and at once set 
about the work. 

If natural breathing has ceased the first thing to be done is to 
free the body from any clothing which binds the neck, chest or 
waist and turn it upon the face for a moment, thrusting the finger 
into the mouth and sweeping it around to bring away anything that 
may have gotten in or accumulated there. The body should be 
then laid flat on the back, with something a few inches in height 



MEDICAL AND SURGICAL EMERGENCIES. 77 

tinder the shoulders — anything will do ; a folded blanket, a shawl, 
coat, or stick of wood — so as to cause the neck to be stretched out 
and the chin to be carried far from the chest. The tongue should 
now be drawn well forward out of the mouth and held by the 
assistant, or, if there be no one to do this, a pencil or a small stick 
may be thrust across the mouth on top of the tongue and back of 
the last teeth, to keep the mouth open and tongue out of the throat. 
A very good way to get the base of the tongue clear of the wind- 
pipe is to press the angles of the jaw forward with both thumbs 
applied just in front of the lobes of the ears. 




Fig. 11. No. 1, Showing position and movements of the body in accidental drowning. 

An effort to secure artificial respiration should now be begun. 
The simplest way to do this is for some one to place himself on his 
knees behind the head, seize both arms near the elbows and sweep 
them around horizontally, away from the body and over the head 
till they meet above it, when a good, strong pull must be made 
upon them and kept up for a few seconds. This effects an inspira- 
tion — fills the lungs with air, by drawing the ribs up and so enlarg- 
ing the cavity of the chest. 

The second maneuver consists in returning the arms to their 
former position alongside of the chest, and making strong pressure 
against the lower ribs, so as to drive the air out of the chest and 
effect an act of expiration. This need occupy but a second of 
time. If this plan is completely carried it will make about sixteen 
■complete acts of respiration a minute. 

These movements, alternating as stated above, should be kept up 



78 MEDICAL AND SURGICAL EMERGENCIES. 

for a long time and not abandoned until a competent person has 
ascertained that the heart has ceased to beat. 

The cessation of pulse at wrist amounts to nothing as a sign of 
death, and often life is present when only a most acute and prac- 
ticed ear can detect the sound of the heart. In a moderately thin 
person, deep pressure with the finger ends just below the lower end 
of the breast bone may sometimes reveal pulsation in the main 
artery of the body, situated there, when it cannot be found else- 
where. 




Fig. 12. No. 2, Showing second movements in accidental drowning. 

It is important that the wet clothing as soon as possible shall be 
removed from a drowned person. This can always be done with- 
out interrupting the artificial respiration. The wet clothes may 
be loosened and drawn down over the feet. Then the body may be 
slipped quickly on to something dry and covered with some dry 
fabric. Bodily heat must be restored and maintained by artificial 
heat and means which ingenuity under the circumstances may sug- 
gest—hot bottles, plates, bricks, stones or even boards that have 
lain in the summer's sun. At the sea-shore there is plenty of hot 
sand. The body and limbs may be gently but constantly rubbed 
toward the heart, to help the blood in its labored circulation. 
None of these things need interfere with the efforts to secure 
respiration, which must be uninterrupted. 

Some stimulant is to be given as soon as it can be swallowed ; 
teaspoonful doses of brandy or whisky in a tablespoonful of hot 
water may be given every few minutes till the danger point is 
passed. 



MEDICAL AND SURGICAL EMERGENCIES. 79 

When natural respiration begins to be noticed it should be aided 
as much as possible by timing the artificial to it. It may also be 
stimulated by the application of smelling salts, hartshorn, spirits of 
camphor, snuff or even tobacco to the nose, by slapping the skin, 
or by dashing hot water upon the chest. When it is available 
there is no better stimulant to respiration than that of a good 
Faradic battery, used so as to cause a reflex sobbing or deep 
breathing by the pain it causes. Little by little natural breathing 
will take the place of the artificial, but close attention is required 
for some time. Nothing but danger from cold or pressing neces- 
sity should prompt the removal from one place to another of a 
person who is being resuscitated before this has been thoroughly 
accomplished. If removal cannot be avoided it must be effected 
with great care. After resuscitation the person should be put in 
a warm bed, and carefully watched to see that breathing does not 
suddenly stop. 



POISONS. 

Unknown Poisons — Acid Poisons — Ai^kaijne Poisons — 
Metaujc Poisons — Vegetable; Poisons— R^sum^. 

Immediately upon the discovery or suspicion of poisoning, some 
one should be dispatched for a doctor, if possible, carrying infor- 
mation as to the poison taken, so that valuable time may be saved. 
Meanwhile the following may be done : 

I. Unknown poisons. If the patient should vomit, this may 
oe encouraged ; if not, it must be provoked. The simplest way to 
do this is to give large draughts of lukewarm water, and thrust a 
finger down the throat. If there be time, and it is at hand, a tea- 
spoonful or two of ground mustard may be stirred up in the 
water, or a teaspoonful of powdered ipecac, or a tablespoonful of 
the syrup of ipecac. Further, let it be remembered that there is 
no occasion for fastidiousness. Any water will do. Water in 
which hands — or dishes, for that matter — have been washed, may 
by its very repulsiveness, act more quickly than anything else ; and 
if soap has been used, it will be all the better for that, as soap is 
an antidote for acid poisons. The quantity used must be large; 
the sufferer must be urged to drink and drink, a large quantity at 
a time, until he can contain no more, and has been made to vomit 
over and over again. 

After copious vomiting, soothing liquids should be given — oil, 
milk, beaten-up raw eggs — all in moderately large quantities. 
These are especially valuable when the poison has been of an 
irritating character. 

If the sufferer be much depressed in body or in mind, the hands 
and feet cold, the lips blue, the face pale, a cold perspiration upon 
the forehead and about the mouth, then some stimulant may be 
administered. Strong, hot tea, without milk, is the best, because it 
is a chemical antidote to many poisons. Strong coffee is next in 
value. To either of these can be added brandy, whisky, wine, or 

80 



MEDICAL AND SURGICAL EMERGENCIES. 81 

alcohol, in teaspoonful doses for an adult, and half as much for a 
child ; the spirits should be mixed with a little hot water. Warm 
coverings are not to be forgotten ; and if the depression be great, 
hot water cans or hot bricks, wrapped in one or two thicknesses of 
blanket, should be placed by the side of the chest, or a huge 
poultice placed round the body, or a blanket, wrung out of hot 
water and covered with a dry one. 

2. Acid poisons. Oil of vitriol (sulphuric acid), and nitric and 
muriatic acids are heavy, sometimes yellowish looking fluids; the 
first, as its name implies, not unlike oil in appearance, but very 
heavy in a bottle. The others are lighter, and give off extremely 
pungent, irritating fumes. All discolor anything on which they 
fall ; the first blackens white pine wood, the others turn it yellow. 
All burn horribly and leave no doubt of their caustic nature. 

For these the proper treatment is to give an alkali. A table- 
spoonful of hartshorn may be mixed with two teacupfuls of water, 
and given; or almost unlimited quantities of soda, magnesia, 
potash, whitewash, chalk, tooth powder, whiting, plaster, soap, or 
even wood ashes, stirred up in water. 

After this should come the provoking of vomiting; then the 
bland fluids mentioned above should be administered, rest secured 
and stimulation employed, if necessary. 

Oxalic acid comes in small, heavy, bright, colorless crystals, 
making a clear rattle in a bottle or jar. For this the best antidote 
is lime in some form. If lime water is at hand, it may be given 
freely, or whitewash, tooth powder, chalk, whiting, or plaster 
from a wall. The latter may be crushed and stirred up in water, 
without regard to the grittiness, which will not do any harm. 

Carbolic acid is usually in solution, as a thick, clear and dusty 
fluid. When taken by the mouth it causes whitening and shrivel- 
ing of the mucous membrane, lining it with intense burning, and 
then numbness. There is also nausea, weakness and depression, 
sometimes actual collapse. It is a very dangerous poison, because 
it acts rapidly and benumbs the stomach, so that it is hard to 
provoke vomiting. This must be attempted, however, and large 
draughts of oil, white of egg, magnesia and water, or milk must be 
given. Rest, warmth of the body and stimulation must also be 
secured. 

3. Alkaline poisons. The strong alkalies are ammonia, or 

6 



82 MEDICAL AND SURGICAL EMERGENCIES. 

hartshorn — which is a clear fluid with an unmistakable odor — - 
potash and soda, usually dissolved, and sometimes in the form of 
lye. Liniments sometimes contain these substances, and are 
swallowed by mistake. 

The alkalies usually burn intensely. They must be combated 
with an acid. Vinegar can always be had, and there is nothing 
better. It should be given undiluted, and a pint at a time, if possi- 
ble. Lemon juice may be used, or even orange juice, though the 
latter is too mild an acid to be of much service, unless the oranges 
are very sour. Vomiting should then be provoked, and followed 
by bland acid or oily drinks, rest and stimulation, if necessary. 

4. Metallic poisons. Arsenic, sugar of lead, corrosive subli- 
mate, and tartar emetic are not infrequently taken by mistake, be- 
cause they are taken for various household purposes. 

Arsenic comes as a white, sweetish powder, often used to de- 
stroy domestic pests, such as rats and roaches. It usually excites 
vomiting and violent pain in the stomach. At once large quanti- 
ties of milk, white of egg, or flour and water, or oil and lime water 
must be given. The vomiting must be encouraged or provoked, 
and dialysed iron given. This can now be obtained at any drug 
store, and should be given freely, in tablespoonful doses, each 
dose being followed at once by a teaspoonful of common salt in a 
teacupful of water; or if this is not at hand, equal parts of sul- 
phate of iron (green vitriol) and carbonate of soda may be dis- 
solved in separate cups of hot water and then mixed and drunk. 
Afterward vomiting should again be provoked, followed by a 
dose of castor oil. 

Paris green is an arsenical preparation. If taken as a poison, 
it must be treated like simple arsenic. 

Sugar of lead comes in white lumps or powder, and calls for 
vomiting, Epsom salts, milk, eggs, and castor oil. 

Corrosive sublimate comes in small colorless crystals, or in a 
clear solution. If taken, vomiting must be provoked, and some 
form of tannic acid given. Strong tea is the handiest thing con- 
taining this, and its administration should be followed up with 
eggs and milk. 

Tartar emetic, a white powder, is best treated in the same way. 

Phosphorus is sometimes chewed off matches by children. It 
is a poison which acts slowly, and affords ample time for securing 



MEDICAL AND SURGICAL EMERGENCIES. 83 

medical advice. But five-grain doses of sulphate of copper, dis- 
solved in water, may be given, at intervals of ten minutes, until 
vomiting comes on. Then a dose of magnesia should be admin- 
istered ; but no oil. 

Lunar caustic is sometimes swallowed. The antidote of this 
is a very strong brine of salt and water, given again and again ; 
and vomiting should be provoked, until the vomited matters cease 
to have a look like thin milk. 

Iodine, in the form of a tincture, is also sometimes swallowed 
by mistake. The antidote for this is starch and water. 

5. Vegetable poisons. The vegetable poisons are so often 
taken in consequence of mistakes in the use of medicines, that it 
is a wise precaution that a poisonous drug should always be con- 
tained in a bottle of peculiar shape, or with something peculiar 
attached to its neck, and that there should also be a special place 
in each house where dangerous remedies, and such as are intended 
for external use, should be kept. 

Opium preparations are opium, morphine, laudanum, paregoric, 
black drop and many poisonous nostrums sold as soothing-syrups, 
pain-destroyers, and drops for infants. Their symptoms are deep 
sleep, with narrowing of the pupil of the eye to a small circle, 
which does not enlarge in the dark. Here emetics must be used 
promptly and persistently, and vomiting produced over and over 
again. Strong coffee must be freely given as a stimulant. So 
long as the breathing does not fall below ten to the minute, there 
is no immediate danger of death ; but opium is a treacherous 
poison, and requires all the skill that can be obtained to combat it. 
The important matter is to keep up the breathing. The custom 
of walking a patient up and down and slapping him with wet 
towels is to be deprecated, because it adds exhaustion to stupor. 
If an electrical battery can be obtained, and used, it is the best 
thing that can be done. The Faradic current should be used, and 
applied so as to stimulate the sensory nerves in the skin, so that 
they shall excite reflex acts of deep breathing. The next best 
thing is to lay the patient upon a lounge and slap his skin with the 
back of a broad brush or with a slipper. This is all the rousing 
that is necessary, so long as the breathing keeps above ten to the 
minute. Should it fall below this, or if the breathing should cease, 
artificial respiration should be employed. 



84 MEDICAL AND SURGICAL EMERGENCIES. 

Chloral is a damp, colorless, crystalline substance, usually seen 
in solution. Its symptoms and treatment are the same as those 
of opium. 

Strychnine is an intensely bitter, white powder. It produces 
stiffness of the jaws, then of the limbs and body. It should be 
treated by provoking vomiting, giving a purge, and doses of 
thirty grains of bromide of potash, or twenty grains of chloral, or 
both, to an adult. The greatest quiet must be secured. The 
poisoned person should be put to bed in a darkened room, with 
doors, windows and shutters arranged in a way that shall exclude 
all sights, sounds and draughts, though permitting good ventila- 
tion. 

Aconite is sometimes contained in liniments, and swallowed by 
mistake. In such a case vomiting must be brought on, and fol- 
lowed by the administration of stimulants. Strong coffee may be 
used, hartshorn (a teaspoonful in a teacupful of water), wine, 
whisky, or brandy. The patient will often feel a peculiar numb- 
ness or tingling in the arms or legs, which is an evidence that the 
poison has entered the blood, and makes the attention of a physi- 
cian imperative. If there is depression, warmth should be used, 
as described when speaking of unknown poisons. 

Hemlock, Deadly Nightshade, the Jamestown (or Jimson) 
Weed, Monkshood, and Toadstools are sometimes eaten, without 
knowledge of their poisonous character. Tobacco, too, sometimes 
causes poisonous effects. All produce deep depression, and must 
be treated with vomiting, followed by stimulation and warmth, 
very much as in the case of aconite poisoning. 

Alcoholic liquors are sometimes taken in such large quantities 
as to be poisonous. When this is the case, there are evidences of 
deep stupor or depression. The course to be pursued is to cause 
vomiting, give hartshorn and water (a teaspoonful in a teacup- 
ful), and keep the body warm. 

6. Decayed meats or vegetables usually excite vomiting, which 
should be encouraged until the stomach is empty, and followed 
by a dose of castor oil and some powdered charcoal. 

Resume. We have now completed the list of poisons that are 
at all common, and have seen what should be done in almost any 
case that is likely to occur. In conclusion, let it be remembered 
that when there is an alarm of poisoning, some one, at least, must 



MEDICAL AND SURGICAL EMERGENCIES. 85 

keep cool; then that a physician is to be summoned (sending him 
word, if possible, what poison has been taken) ; and that, until 
his arrival, the course indicated above should be followed. To 
save time in an emergency, the following table may be consulted, 
which gives the name of each poison we have already studied, and 
the proper treatment for it. 



POISON. 



Unknown. 



Acids- 
Sulphuric. . . ^ 
Nitric . . . 
Muriatic. 
Oxalic... 

Arsenic — 



> 



Paris green ) 

Scheele's green.. ) 



TREATMENT. 

f Provoke repeated vomiting, 
Give bland liquids, 
Stimulate, if necessary. 



Give an alkali, 
Provoke vomiting, 
Give bland fluids, 
Secure rest, 
Stimulate, if necessary. 

Provoke vomiting, 

Give dialysed iron and salt, 

Give dose of castor oil, 

Secure rest, 

Stimulate, if necessary. 



Sugar of lead < 



Give Epsom salts, 
Provoke vomiting, 
Give bland liquids, 
Give dose of castor oil. 



Repeat 
several 
times. 



Repeat 

several 

times. 



Alkalies — 

Hartshorn "I 

Soda ! 

Potash.... ! 
Lye J 



Corrosive sublimate 
Tartar emetic 



Phosphorus. 



Lunar caustic (nitrate 
of silver) '. 



Iodine 



Give an acid (vinegar), 
Provoke vomiting, 
Give bland liquids, 
Secure rest, 
Stimulate, if necessary. 

Provoke vomiting, 
Give strong tea without milk, 
Give raw eggs and milk, 
Give dose of castor oil, 
Stimulate, if necessary. 

r Provoke vomiting, 
Give five-grain doses sulphate 
of copper, or teaspoonful 
doses of turpentine. Give 
doses of magnesia, but no 
oil. 

Give strong salt and water, 
Provoke vomiting. 

Provoke vomiting, 
Give starch and water, 
Give bland fluids. 



Repeat 

several 

times. 



Repeat 
many 
times. 



86 MEDICAL AND SURGICAL EMERGENCIES. 

POISON, TREATMENT. 

Opium — 

Morphine *| f Provoke vomiting, repeatedly, 

Laudanum > -J Give strong coffee, without milk, 

Paregoric, etc... J ^ Keep up the breathing. 

Chloral ( Same as opium ) 

f Provoke vomiting, 

Croton oil < Give bland fluids, and laud- 

[ anum or paregoric. 

f Provoke vomiting once or twice, 

Strychnine •{ Give a purgative, 

L Secure absolute quiet. 

A ^ f Provoke vomiting. 

Aconite ..... . ... I Stimulate well * 

Veratrum vinde ... J | Reep head ^ 

Jamestown weed 

Hemlock 

Nightshade 
(belladonna) . 

Toadstools 

Tobacco 



Provoke vomiting, 
Stimulate well. 



» , i , ( Provoke vomiting, 

Alcono1 ( Give hartshorn and water. 

-r^. , , f Provoke vomiting, 

Decayed meats or vege- J Giye a purgative f 

taDles t Give powdered charcoa.. 

To provoke vomiting, warm water may be used with or without 
ground mustard (a tablespoonful to a pint of water), or ipecac 
(a teaspoonful of the powder or a tablespoonful or so of the 
syrup), and thrusting a finger down the throat. It is best to give 
large quantities (that is, a pint at a time) of warm water whenever 
vomiting is to be excited. 

Bland liquids are milk, tea, coffee, whisky, wine, etc., or harts- 
horn and water. Of this a teaspoonful in a teacupful of water will 
be enough for a dose. In making tea or coffee one must not wait 
to do it as if for the table, but mix hot water and the leaves or 
grounds, squeeze them well, stir together, and give the whole — 
leaves, grounds, everything. At the same time some may be made 
regularly, if there are conveniences for it. 

Alkaline antidotes are hartshorn and water (a tablespoonful in 
two teacupfuls of water), soap and water, lime, whiting, soda, 
chalk, tooth powder, plaster, magnesia, whitewash, and even wood 
ashes. 



MEDICAL AND SURGICAL EMERGENCIES. 87 

Acid antidotes are vinegar and lemon juice. In giving an anti- 
dote never wait for it to dissolve. Just stir it up in any fluid at 
hand except oil, and have it swallowed immediately. 

When laudanum is advised for such an irritant poison as croton 
oil, it must be given in a dose of half a teaspoonful to an adult, 
and this may be repeated in half an hour if the pain continues to 
be severe and there is no drowsiness. 



SUNSTROKE. 

Cause — Treatment and Subsequent Course of the Disease — 
Action of Cold Water. 

The following cases occurred in the wards of the Presbyterian 
Hospital, in the service of Dr. J. P. Thornley, with whose kind 
permission they are reported. 

During the six days from August 8th to 13th, inclusive, about 
one hundred and ten persons were brought to the hospital suffering 
more or less from the excessive heat. About fifty of the cases were 
of the milder forms, and not included in the report. Cold water 
was given, with which they sponged their heads and chests, and 
they were kept in a cool room and left the hospital in from fifteen 
minutes to twelve hours. 

Cause. The cumulative action of the heat was pronounced; it 
was the third day of excessively high temperature and humidity 
when the first cases occurred. Then, on six successive days there 
were two, six, ten, twenty-one, seven, and four, respectively. Of 
the fifty cases, twenty-seven were between three and eight o'clock 
in the afternoon, four from eight o'clock to midnight, four from 
midnight to 6 a. m., and six more before noon. From noon to 3 
p. m., nine cases were brought in. Thus there were forty cases 
from noon to midnight, and but ten from midnight to noon. There 
were but few in women, forty-six of the sixty-one cases being 
men. 

The occupation of most of the patients involved exposure to the 
sun, though in a fair number, including all the women, this was 
not so. 

The average age was thirty-six years, the oldest being seventy 
and the youngest nineteen years of age. 

With few exceptions, the patients were large-framed, well- 
muscled, and robust individuals. Those that were the reverse did 
poorly as a rule. 

88 



MEDICAL AND SURGICAL EMERGENCIES. 89 

Only one had had a previous attack, and that was on the day 
before admission. His was a fatal case. 

The use of alcohol seemed to have a direct and unfavorable in- 
fluence. The habit was marked in thirty-two per cent. ; moderate 
in forty-six per cent. ; denied in ten per cent. ; in the remaining 
twelve per cent, no history was or could be obtained. Eight per- 
sons were markedly alcoholic on admission, and of these four died. 

Treatment and subsequent course of the disease. The ambu- 
lance suregons were instructed to at least start undressing the 
comatose patients on their way to the hospital. Immediately after 
admission they were stripped of clothing, which took about thirty 
seconds. They were then immediately put into the bath, at least 
one of the house staff directing the treatment in each case. 

With the first five cases the netted cot was used, the patient being 
constantly rubbed and sponged with ice- water. They were all in 
coma, and the sponging was used only because the tubs were not in 
readiness, the cots having been sufficient for the small number of 
cases treated in previous years. 

The average temperature in these cases was 110.3 F., the lowest 
105. 6° F., the highest 115 F. Thirty-two minutes was the average 
duration of the bath, varying from fifteen to fifty minutes. The 
baths were stopped at from 104.5 ° to 100.6 F., the average tem- 
perature of the patients when removed being 101.7 F. Following 
the bath at an average interval of fifty minutes, ranging from, 
thirty minutes to two hours, the temperature fell to from ioo° to 
59 F., the average being 98 ° F. 

The tub bath was used in thirty-six cases, including those of all 
the comatose and delirious, and that of one conscious patient. The 
water was as cold as it could be kept, with ice constantly floating 
in it, usually at about 40 F. Four attendants continually rubbed 
briskly all parts of the body, the head being constantly bathed. 

The average temperature in these cases was 108.9 F., the lowest 
105 F., the highest 112.2 F. The baths lasted from six to sixty- 
five minutes, the average being twenty-six. When the tempera- 
ture reached from 105 ° to 99.4 F., an average of 103. 2° F., the 
patients were removed from the bath. In a time averaging forty- 
eight minutes, and varying from twenty minutes to two hours, the 
temperature dropped to 97.6 F., as an average, the limits being 
93 and ioo° F. 



9b MEDICAL AND SURGICAL EMERGENCIES. 

Ice sponge baths were also used in five cases of conscious or 
stupid patients, with moderate -temperatures varying from 104 to 
1 05. 2° F., and averaging 104.5 ^. They were bathed from eight 
to forty-five minutes, or an average of twenty-three minutes. The 
temperature at which they were removed was about 102 F., vary- 
ing from 101 to 103 F., falling to 98.9 F., as an average, but 
varying from 99.8 ° to 97 ° F., about forty-six minutes after their 
being removed from the bath. 

In all cases the temperature was taken every five minutes during 
the early part of the bath, and when it began to drop, as quickly as 
the thermometer would register. The temperature rose, even after 
the bath had been started, in five cases, but never rose over o.6° F., 
usually in about five minutes. 

- Only eight patients received stimulation by drugs during the 
bath, and they were patients in whom the pulse was almost imper- 
ceptible. Camphor and ether were used for rapid action, and then 
strychnine, all subcutaneously. 

The stimulating action of the cold water was remarkable. 
Patients that were apparently taking their last gasps would im- 
mediately respire more deeply, and a pulse almost impossible to 
feel would, in the course of a few minutes, be of good quality, 
though rapid. Those in coma would, when the temperature began 
falling, as a rule, rouse up, struggle, and become more or less de- 
lirious. Those delirious would resist the bath vigorously, then 
grow more quiet, and again become restless as the temperature fell 
more. 

On removing the patients from the bath, they were rubbed dry 
with crash towels and covered with a blanket, and hot-water bot- 
tles were placed at their feet. If their condition indicated it, either 
from pulse, respiration, or any considerable falling of the tempera- 
ture, they were further stimulated with camphor and ether, strych- 
nine, digitaline, or atropine, hypodermically, and with whisky and 
hot water by the rectum, or, when possible, by the mouth. 

Hydrotherapy and skilled and careful nursing seem to have been 
the chief factors ; and very frequent recording of the temperature 
enabling the baths to be given at the earliest and, therefore, most 
valuable time ; the use of the ice tub bath, with constant and gen- 
eral friction of the entire surface, thus reducing the temperature in 
the shortest possible time, and being stimulating rather than de- 



MEDICAL AND SURGICAL EMERGENCIES. 91 

pressing; the use of the same bath for all severe secondary eleva- 
tions of temperature, and for the minor elevations sponge baths of 
ice water or of water at from jo° to 8o° F., depending upon the 
individual case; and the repetition of these baths whenever the 
temperature is high enough to make them seem advisable. 
All other means have seemed entirely inadequate. 



HEMORRHAGES OR BLEEDING. •' 

Course op the Arteries — Capillary Hemorrhage — Hemor- 
rhage From the Veins — Hemorrhage From the Arteries — 
For Wounds High up in the Arm — For Wounds op 
Arteries op the Finger — For Wounds op Arteries op the 
Hand — For Wounds Below the Elbow — Wounds op Ar- 
teries op the Foot or Leg — For Wounds in the Thigh — 
Bleeding From the Arteries op the Scalp — Recapitula- 
tion — Bleeders — Treatment — Special Hemorrhages — 
Bleeding From the Mouth — Bleeding From the Nose. 

There is no accident so appalling as hemorrhage, whether the 
bleeding comes from an external wound or from the rupture of 
a blood vessel in some internal organ. There is none which calls 
for so much nerve in combating it, nor any in which a little 
accurate knowledge can be more valuable. 

The subject of the control of the hemorrhage will be better 
understood after taking a concise view of the anatomy of the 
organs of circulation. This cannot be made absolutely accurate 
without being too technical, but the variations from accuracy will 
not affect its practical utility. (See illustration.) 

The blood starts from the left side of the heart, and is driven 
first into the aorta, which curves over above the heart and descends 
along the left side of the spinal column, within the chest and 
abdomen. From what is called the arch, at the beginning, are 
given off vessels which supply the head and arms. The former 
(the carotid arteries) run up alongside the windpipe and divide 
and subdivide in all directions. The latter curve forward and come 
out from under the chest over the first rib, and, passing under the 
collar bone near the shoulder, run down through the armpit and 
inside of the arm to the middle of the front of the forearm, on the 
thumb side, and the other along the little finger side. Thus, in the 

92 



MEDICAL AND SURGICAL EMERGENCIES. 93 

tipper arm the arteries follow nearly the same line as the seam in 
a coat sleeve. The two arteries of the forearm, entering the palm 
of the hand, join in a loop, from which vessels run down, one on 
each side of each finger, and one on the inner face of the thumb. 

The aorta, as it descends through the chest and abdomen, gives 
off vessels to supply the internal organs, and near the lower end of 
the backbone divides and sends two large vessels out through the 
groin into the thigh. Each of these runs down in almost a straight 
line, between the muscles, to the middle of the hollow at the back 
of the knee. Just below this it divides into three branches. The 
first of these passes through to the front, between the two bones of 
the lower leg, and runs down under the muscle, close to the outer 
-side of the shin bone, and passes out upon the instep at about the 
middle of the front of the ankle joint. Here it breaks up into 
smaller vessels that supply the top of the foot. 

The second and third branches of the main artery of the thigh 
pass down the back of the lower leg, one on each side, close to the 
corresponding bones, and deep under the muscles. One passes 
oack of the inner ankle bone into the inner side and sole of the foot. 
The other passes back of the outer ankle bone, to the outer side and 
sole of the foot. The arteries of the sole of the foot, like those of 
the palm of the hand, unite to form a loop, from which a vessel is 
given off for each side of each toe. 

COURSE OF THE ARTERIES. 

This is a brief outline of the course of the arteries. As they 
■divide and subdivide, like the branches of a tree, they become cor- 
respondingly smaller, and they end in an inexpressibly fine net- 
work of minute vessels. These are called capillaries. Then, as 
the capillaries are a sort of splitting up of the smallest arteries, so, 
on the other hand, by the confluence of a number of capillaries, 
larger trunks result, toward which the current of blood constantly 
sets, and the beginnings of the veins are formed. These unite in 
a manner the very reverse of the branching of the arteries, and, 
growing, like rills and brooks and rivers larger and larger by re- 
peated junctions of several into one, travel back to the heart in an 
opposite direction to, but alongside of, the arteries. Thus each 
-principal artery has at its side at least one important vein. Up the 



94 MEDICAL AND SURGICAL EMERGENCIES. 

legs, up the inside of the abdomen and chest, up the arms and 
down the neck they pass, till they unite to form one trunk, which 
empties into the right side of the heart. 

From this point the blood is pumped into the lungs to be aerated ; 
from the lungs it is collected and emptied into the left side of the 
heart ; and from the left side, as we have seen, it is pumped out to 
begin the circuit through which we have just traced it. 

The previous illustration will give a fair idea of the course of 
the main blood-vessels, and will make clearer what may not have 
been understood from the preceding description. 

It will be observed that the course of the blood-vessels is always 
in the safest part of the body or limb. They all lie where they are 
protected by bending a limb or joint — a natural act when attacked. 
They are on the inner side of the arm and forearm, when these are 
used for attack or defense. They are on the inner side of the thigh 
and at the back part of the leg — out of harm's way. In endeavor- 
ing, as shall hereafter be recommended, to check bleeding by 
pressing upon a main blood-vessel, this fact may serve as a re- 
minder of the course it might be expected to run. To which this 
suggestion may be added, namely : When you are in doubt, feel for 
the pulsation of the artery and make pressure where you feel it 
beating. Another point, preliminary to considering the methods 
of arresting hemorrhage, is that blood from arteries is usually 
bright red and escapes in jets, while blood from veins is dark red 
or purple, and flows in a steady stream. Blood from capillaries is 
of a color between these two, and it oozes out. 

Capillary hemorrhage follows every cut. The color of the blood 
is red; the flow is generally slow and not very considerable. It 
usually stops of itself. If it does not, the part may be elevated and 
cold water or ice or snow, or even vinegar, applied. If there is 
oozing from a large raw surface, a towel may be folded, dipped in 
water as hot as the hand can possibly bear, lightly squeezed, so as. 
not to drip, and gently pressed upon the bleeding surface. This 
may have to be renewed once or twice, at intervals of a few 
minutes, but it usually acts like magic in this form of hemorrhage. 

Hemorrhage from the veins is generaly slow and steady, and the 
blood is darker than in other forms. It rarely demands special 
effort to control it. When severe, the application of cold, and 
firm continuous pressure upon and below the wound, generally 



MEDICAL AND SURGICAL EMERGENCIES. 95 

suffices to stop it. Rupture of varicose veins in the leg may lead to 
dangerous hemorrhage, but this can usually be checked by applying 
a dry pad of cloth and binding it firmly upon the bleeding spot. In 
this case a ligature applied above the wound would only make 
matters worse. 

A wound of the jugular vein, on the side of the neck, may also 
be followed by dangerous hemorrhage. This is also treated with 
a pad and pressure, which can be best made with one finger laid 
above and one below the wound. 

Hemorrhage from the arteries is very\dangerous. Here the 
blood is bright red, and spurts in a stream orJeaps in jets from the 
divided vessel. If it be from a large artery, such as those in the 
root of the neck or the armpit, or the inside of the thigh near the 
groin, life will usually be quickly lost. Indeed, without a thorough 
acquaintance with anatomy, it is hardly likely that any advice that 
could be given here would be available in such cases. The only 
thing to suggest is to thrust a finger deep into the wound and see 
if firm pressure there will stop the bleeding. Or some other form 
of plug may be tried. The chances of success are, however, very 
slight. 

But every one may, while awaiting skilled aid, do something 
when the arteries of the limbs are cut. The first duty in all such 
cases is to be cool as possible, then, as quick as is consistent with 
coolness. The principle that must guide every attempt to stop the 
bleeding is to obstruct the artery at the spot, or between the center 
of the body and where it is cut ; for this is the direction in which 
the blood flows. 

For wounds high up in the arm, strong pressure may be made 
downward, behind the collar bone, about at its middle (see Fig. 4). 
The thumb, or the handle of a large door key, well wrapped, so 
as to make a tolerably thick mass, can be thrust down, and if it does 
not seem to strike the artery the first time, it can be moved along, 
toward the breast bone and toward the shoulder, to see if it will 
hit the right place. 

For wounds of arteries of the finger, pressure may be made on 
the side, by seizing it between the thumb and finger and pinching 
it, or by wrapping a cord around, or slipping on a rubber band. 

For wounds of arteries of the hand, raising this above the head 
and making firm pressure on the bleeding spot, or with both 



96 MEDICAL AND SURGICAL EMERGENCIES. 

thumbs just above and in front of the wrist, will usually stop the 
bleeding. Or the wound may be packed with lint, or cotton, or 
old muslin, or linen, and bound firmly with a bandage. If this fail, 
resort must be had to the measures recommended for the next 
form of hemorrhage. 

For wounds below the elbow, first grasp the upper part of the 
arm with both hands and squeeze as hard as possible ; then let some 
one make a thick, hard knot, as big as an egg, in the middle of a 
handkerchief, place it over the middle of the front of the arm, im- 
mediately above the elbow, tie the ends tight at the back, and bend 
the forearm up so as to press hard against the knot (Fig. 4). This, 




Fig. 13. View showing compress to stop bleeding from arm. 

if successfully done, will obstruct the main blood-vessel (the 
brachial artery), which in this place lies in the middle line of the 
bend of the elbow. 

For wounds in the upper arm, pressure may be made against the 
hone on the inner side and just below the swelling muscle, of which 
most people are aware is called the biceps, as shown in Fig. 5. A 
knot as big as a fist may be made in any piece of cloth and shoved 
hard up into the armpit, and the elbow then brought straight down 
and held or bound firmly against the side of the chest. 



MEDICAL AND SURGICAL EMERGENCIES. 97 



If either of these methods fail, or cannot be carried out, the 
"Spanish windlass" may be used. To do this, place some hard, 
round body, like a stone, in the large part of a handkerchief folded 
diagonally, and carry the ends of this around the limb, so as to 
leave the lump over the position of the artery — that is, over the 
bend of the elbow, or a little in front of the middle of the inside of 
the arm, near the shoulder. Then tie the ends of the handkerchief 
so as to make a loose loop, slip a stick through this and twist it 
round and round, so as to tighten the handkerchief, till the blood 
stops flowing, but no more ! This is a much rougher procedure 
than the method described before, but one cannot be overparticular 




Fig. 14. View showing compress to stop bleeding from hip. 

in such cases ; so if the former fails, or no bystander is cool enough 
to carry it out, no time must be lost before the "Spanish windlass" 
is used. 

Wounds of arteries of the foot or leg may be treated by firm 

pressure in the hollow just behind the knee (above the calf of the 

leg). This can be effected by placing there a knotted cloth, like 

that suggested for the armpit, and doubling the leg back until it 

7 



98 MEDICAL AND SURGICAL EMERGENCIES. 

presses hard against it. In doing this the thigh must be doubled up 
toward the abdomen or the bending of the knee will soon become 
intolerably painful. 

For wounds in the thigh, pressure must be made in the hollow 
immediately below the groin, about two-thirds of the way from the 
hip bone to the middle line of the body, where the artery of the 
thigh (femoral artery) comes out of the body, as shown in Fig. 
6. This can be effected with the thumbs or with a rounded stick, 
or a key handle, or with a " Spanish windlass." The artery may 
also be closed by placing in the groin a knotted cloth or a large 
round stone, and doubling the leg back on the thigh (this is im- 
portant), and the thigh forward, hard against the abdomen. If 
this latter plan does not succeed promptly some other of those 
mentioned should be tried and no time be lost in doing it. 

Bleeding from the arteries of the scalp can be controlled by firm 
pressure upon and around the bleeding point. 

Recapitulation. To go over this briefly again ; remember : first, 
to keep cool; second, that the principal object is to obstruct the 
artery above the cut ; and that this can be effected by pressure, in 
the several cases, in front of the bend of the elbow, in the armpit, 
behind the bend of the knee, or just below the groin. This can be 
made with the fingers, or with a knot held hard against the artery 
by a tight bandage, or by bending the limb up against it — or, in 
case of the arm, by pressing it hard against the chest. In case of 
failure, the "Spanish windlass" is to be applied to the same places. 

In case none of the plans proposed can be carried out, a cut that 
bleeds profusely may be stuffed with a rag or dry earth, and this 
kept in place by pressure, with a bandage or handkerchief, or the 
cut part may be forcibly compressed in any way, or a finger thrust 
into the wound and held wherever it seems to do most good. 

Finally, let it be remembered that fainting may put an end to 
hemorrhage, and that when consciousness is restored the bleeding 
may recur. So this possibility should not be overlooked. The 
treatment of a faint under these circumstances is the same as that 
of any faint; in addition to the measures demanded to check the 
bleeding, the head must be lowered, the legs and arms may be 
elevated, and warmth applied to the body, while stimulants are 
carefully administered by the mouth. 



MEDICAL AND SURGICAL EMERGENCIES. 99 

BLEEDERS. 

There are persons who are known as bleeders ; they belong to the 
class known to the medical profession under the name of "Hemor- 
rhagic diathesis." These individuals may bleed to death from a 
very slight wound ; extraction of a tooth has been followed by 
death from bleeding, also from the nose or in almost any other 
part. The bleeding may occur in some internal organ and death 
occur when the cause is very obscure. This condition is generally 
hereditary and often affects several members of the same family. 
The tendency to this form of bleeding may occur as early as the 
first year of life, but there is nothing in the appearance that indi- 
cates the existence of this form of hemorrhage, and it is not gen- 
erally known until the act, a fall on the nose or the pulling of a 
tooth, starts a bleeding which is uncontrollable ; the bleeding will 
be slow, oozing for days, until death comes from exhaustion and 
loss of blood. However, in many cases the bleeding slowly ceases 
and, after a long period, the person recovers. The blood may be 
discharged into the stomach, intestines, lungs, kidneys and brain. 

An entire family of "bleeders" has been discovered in New 
York. The family consists of seven members, father, mother and 
five children, four of which are boys (all bleeders), the fifth is a 
girl six years of age, who up to the present time has shown no in- 
clination to bleed more than any ordinary child. 

The oldest child, now twelve years of age, has had severe 
hemorrhages on an average once every year since he was two years 
old, the bleeding would continue from three weeks to three months 
before it could be stopped. Bleeding from the gums had been 
almost constant since he was five years of age. During the day 
the blood is expectorated, while at night it is either swallowed or 
allowed to flow out upon the pillow. 

The other boys have all had severe attacks of bleeding. One of 
them remained unconscious for five days from the loss of blood. 

The daughter, who is six years of age, has been cut and injured 
repeatedly, but up to the present time she has shown no inclination 
to bleed abnormally. 

This bears out the statement recently printed to the effect that 
bleeders are usually of the male sex, although the disease is trans- 
LofC. 



ioo MEDICAL AND SURGICAL EMERGENCIES. 

mitted by a non-bleeding member of a bleeder family and almost 
invariably by a female member. 

SPECIAL HEMORRHAGES. 

In bleeding from the mouth the blood must come from the gums, 
the throat, lungs or stomach. The most dangerous is bleeding 
from the lungs, and it is necessary to be able to determine whether 
the blood comes from the stomach or from the lungs. 

The following symptoms will be experienced when the blood 
comes from the stomach : a sense of warmth and fullness over the 
chest, with nausea and vomiting, paleness of the face, the surface 
becomes cold and clammy and the blood rushes up in a full stream 
through the mouth and nose and is often expelled during the dif- 
ferent acts of vomiting. The only other disease with which this 
bleeding is liable to be confounded is that of bleeding from the 
lungs. The person suffering from hemorrhage of the lungs will 
experience a sense of nausea with constriction across the chest, 
difficulty in breathing, and there will also be a hacking cough. The 
blood is coughed up in mouthfuls, bright red, frothy and mingled 
with sputum; there is also a sense of trickling behind the breast 
bone and for a few days after the bleeding has stopped the spittle 
will be tinged with blood. When the blood comes from the stomach 
there will often be found mixed with it particles of food and it 
will generally be of a darker color than when it comes from the 
lungs. Bleeding from the stomach does not often cause immediate 
death, except when due to some disease of the stomach, such as 
cancer, or ulceration, or diseases of the liver. 

When bleeding from the nose the blood will nearly always be 
seen in the nostrils, and there is no cough, and it becomes thick 
and coagulates readily. When the blood comes from the teeth or 
gums it can be readily detected by looking into the mouth and 
examining the parts. 

All these varieties of hemorrhage, from the lungs, stomach, nose 
and mouth, often come on suddenly, and valuable time is lost on 
account of the ignorance of those present. The two former are the 
most serious ; in the treatment of these the first thing to be done is 
to keep the person absolutely quiet and in a horizontal position ; ice 
should be taken freely and ice-bags applied across the chest; if 



MEDICAL AND SURGICAL EMERGENCIES. 101 

ice-bags are not at hand, cold cloths, wrung out of cold water 
should be applied. If, upon examining the pulse, the heart is weak 
and the person faint, a small amount of stimulants should be given ; 
about a tablespoonful of brandy in about twice as much water. 
These remedies, which should be always at hand, if used intelli- 
gently, will be found of great benefit and will, in instances, save 
lives and will give the sick and dangerous person all the help that 
can be given during the time until the services of a physician are 
secured. 

Bleeding from the nose is often only nature's way of getting rid 
of an excess of blood ; but it may be so profuse as to threaten life. 
If this be the case, of course, medical aid will be summoned; but 
until it arrives the best thing that can be done is to snuff salt and 
water, or vinegar up the nose. A strong solution of alum in very 
warm water is also useful ; but vinegar is less disagreeable, and will 
rarely fail to check the bleeding, unless the case is beyond any 
except skilled help. 

Treatment: For this form of hemorrhage the same remedies 
must be used with greater persistence than in other forms of 
hemorrhage ; when the loss of blood is great, as it usually is, tonics 
of iron should be administered; from ten to twenty drops of the 
tincture of chloride of lime, three times per day, should be taken 
for several weeks, and a good and nourishing diet, composed of 
milk, eggs, and fresh meats should be combined with a moderate 
amount of exercise. With this treatment, also careful attention 
to the bowels, patient will slowly recover. When this inclination 
to bleeding is known to exist the person should avoid all conditions 
which would give rise to a hemorrhage in any part. 



MEDICAL AND SURGICAL EMERGENCIES. 

Supplies for Emergencies — Surgical Case — Use op Contents 
op Surgical Case — How to Make Poultices — Medicine 
Chest — Doses and Uses op the Medicines. 

supplies for emergencies. 

The suggestions in the preceding pages have been, so far as 
practicable, such as could be carried out without having made any 
special provision for them. Nevertheless, occasionally appliances 
and remedies have been suggested, which would very much facili- 
tate the treatment. These may be divided into medical and surgi- 
cal. They may be arranged separately or together, but the former 
arrangement would probably best suit individual necessities. 

SURGICAL CASE. 

A surgical case suitable for almost any emergency should not 
contain so many things as to confuse one who has not a medical 
education. Its supplies should be few and simple, such as — 

i. Some absorbent cotton. 

2. A roll of old muslin or linen. 

3. Bandages, two and one-half inches wide and six yards long, 
rolled up. 

4. Rubber adhesive plaster, on a spool, in a strip two inches 
wide, and not less than a yard long. 

5. Scissors. 

6. Pins (ordinary and safety pins). 

7. Needles threaded with stout thread. 

8. A bottle of hartshorn, with a glass or rubber stopper. 

9. A bottle of laudanum, with dose marked on it. 
10. A bottle of good whisky or brandy. 

102 



"■ 



MEDICAL AND SURGICAL EMERGENCIES. 103 

USE OF THE CONTENTS OF THE SURGICAL CASE. 

1. Absorbent cotton can be obtained at any drug store. It is 
perfectly clean and soft, and is prepared in such a way that — in- 
stead of resisting moisture, as ordinary cotton does — it will absorb 
it with great rapidity. Thus it will take up discharges from 
wounds, and when a cool or hot application is desired, it can be 
soaked with cool or hot water. Sometimes it is very convenient 
to put it on dry, and then squeeze the water upon some part of it 
from a sponge, when every part will rapidly become saturated. 

For padding splints, or making cushions to prevent pressure of 
any kind, there is nothing so good as absorbent cotton. 

2. Old muslin or linen can be torn into any shape or size that 
may be required, and can be used to spread poultices upon. It is 
also useful to make broad slings of. 

3. Bandages of the kind described are used to keep applications 
in place, to secure parts to splints, and to prevent injurious motion. 
The simplest way to apply them is to make circular turns around 
any part. When the latter is of even size this is a very easy matter. 
Where the part is larger at one end than the other, the ordinary 
circular turns would not fit smoothly. To accomplish this, the rule 
is to begin at the small end and make a few turns, round and' 
round, one immediately over the other, and then to begin to move 
up the limb spirally. So long as a turn can be made to smoothly 
overlap the one before it about one-third, this spiral is all that is 
required. But as soon as it puckers, the bandage is not carried on 
as before, but is turned down, so that the inner face now looks out, 
and the bandage instead of passing up, passes downwards, so as 
to make a sort of inverted V — so, A. On now carrying the band- 
age on round the part, it will be found that it comes to the front, 
just overlapping the preceding turn, and the same process can be 
repeated, until the whole bandage is neatly applied. 

At joints, like the ankle, knee, and elbow, the bandage may make 
a sort of figure 8, the middle or crossing part being in the bend of 
the joint, and the two loops, one above and one below it. 

Bandages should never be put on so tight as to cause pain, and 
never drawn tighter above than below. 

Bandages may be fastened by pins, by stitching, by strips of 
adhesive plaster, or by splitting the end and carrying one tail on 



io4 MEDICAL AND SURGICAL EMERGENCIES. 

as before and turning the other back to meet it and then tying the 
two together. For narrow bandages, the latter is the simplest 
plan ; for wide ones some one of the others is better. 

The width of two and one-half inches is that which is oftenest 
convenient. When a narrow bandage is called for — as for a finger 
— one of the former may be torn down the middle ; or if rolled up, 
it can be laid on a firm surface and the whole roller cut in half 
with a sharp knife, just as one would cut a sausage. This quickly 
and easily makes two good finger bandages. 

4. Rubber adhesive plaster is better than any other kind, because 
it can be applied without any heat or moisture. It sticks of itself. 
When applied to a hairy part, the hair should be shaved off if 
possible. If not, when the plaster comes to be removed, it must be 
soaked off, or it will pull the hair out and cause great pain. 

Another point to be remembered is, that in changing adhesive 
plaster dressings only so much should be removed as is necessary 
or as cleanliness demands. The rest may be left on and the new 
dressing applied up to it or over it. 

The plaster is most convenient to use when in strips, which can 
be cut easily and without waste if needed smaller, and additional 
strips applied side by side, if a greater width is wanted. 

5, 6, 7. The use of scissors, pins and needles need not be ex- 
plained. 

The points of pins should never be left sticking out, and care 
should be used to avoid sticking either pins or needles through the 
patient's skin. 

8. Hartshorn is to be used as a stimulant to the heart and to the 
nervous system. A teaspoonful may be put into a tumblerful of 
water and a teaspoonful of the mixture given every few minutes. 
Its use by the nose everybody is familiar with. Yet it may be 
worth while to say that a full bottle of hartshorn should never be 
brought near to a patient's face. The stopper may be wetted and 
held under the nose, or a few drops put on a handkerchief, or the 
hand, and used in the same way. 

9. The laudanum bottle should be marked "Poison!" and have 
the dose marked on the label. In surgical cases, where there is 
much pain, a full dose is called for, and to give less is to trifle 
with the sufferer. 



MEDICAL AND SURGICAL EMERGENCIES. 105 

As already remarked, laudanum is one of the very best local 
applications to wounds and bruises. It can be used by soaking a 
proper quantity of absorbent cotton, or a piece of old muslin, and 
laying it upon the injured part. 

10. About the whisky, it may be remarked, that a large dose is 
almost invariably useless or injurious. Even for an adult — unless 
a confirmed drinker — the proper dose is a teaspoonful in a small 
quantity of hot water — or cold water, if hot cannot be had — re- 
peated every few minutes until some effect is produced, or a couple 
of ounces — about half a small teacup ful — have been given. 

HOW TO MAKE POULTICES. 

Poultices. The commonest materials for poultices are bread, 
flaxseed, hops and mush. A hop poultice may be made by pouring 
hot water upon hops till they are well moistened. A bread poultice 
is made by soaking the inside of bread in hot water or milk, and 
mashing it quite soft and even. With flaxseed or corn-meal the 
way is to put the poultice material on a plate, and add just enough 
hot water to moisten it. This is worked in with a large spoon or 
table knife, just as a salad dressing is made. Then to this thick 
but damp mass, enough hot water is gradually added and worked 
in until the whole is almost soft enough to run, but not quite. 
Poultices should be spread thick. To spread a poultice, a piece of 
fine, old muslin (or a piece of open-meshed stuff, such as cheese 
cloth is made of, can be used), twice as long as the poultice is to 
be, is laid on a flat surface, and one-half of it spread smooth with 
the poultice material. The other half is brought over and 
pressed down on top of the poultice material, or another piece of 
muslin, or a piece of tarlatan can be used for this purpose, so that 
the poultice material shall not come into immediate contact with 
the skin ; then, when it comes time to be removed, it will come off 
easily, all at one time, and not leave any behind to stick to the 
skin. 

A poultice must be put on hot. To secure this, it may be spread 
over a hot plate. A simpler plan, however, is to take the finished 
poultice up by its edges and lay it for a moment or two on some- 
thing hot, or dip it into a vessel containing boiling water. Care 
must however be taken not to put on a poultice so hot as to burn. 



106 MEDICAL AND SURGICAL EMERGENCIES. 

To keep a poultice warm when applied, it should be covered with 
oiled silk or several folds of bandage. 

It may be remarked that nothing has been said here about the 
use of "lead water and laudanum" or arnica, so often recommended 
for bruises and cuts. The reason for this omission lies in the fact 
that neither has any merit superior to that of cold water or lauda- 
num alone. When a part is hot and angry, there is nothing better 
for it than the use of cold water constantly renewed until the heat 
and irritation have subsided. When pain is to be combated, lauda- 
num alone is the best thing to use locally. 

MEDICINE CHEST. 

A small box can be bought or made, to hold a few things likely 
to be useful in accidents or sudden sickness. It ought to contain — 
Absorbent cotton. 

Sticking plaster — rubber plaster (on a spool) is best, because it 
requires neither heat nor moisture for its application. 
Bandages of old muslin or flannel. 
A piece of oiled silk. 
Thread and needles. 
Pins (ordinary and safety pins). 
Cosmoline, vaseline, or cold cream, 
i. Aromatic spirits of ammonia. 

2. Tincture of asafetida. 

3. Oil of cloves. 

4. Hoffman's anodyne. 

5. Syrup of ipecac. 

6. Laudanum. 

7. Magnesia. 

8. Mustard. 

9. Paregoric. 

10. Spiced syrup of rhubarb. 

11. Turpentine. 

To these may be added, if quite convenient: camphor water, 
essence of ginger, lime water, and sweet spirits of nitre. 

Of the eleven first named, a convenient quantity to have would 
be two fluid ounces; except of No. 3 (oil of cloves), of which a 
fluid drachm would be plenty, and No. 7 (the magnesia), and No. 
8 (the mustard), of both of which an ounce would suffice. 



MEDICAL AND SURGICAL EMERGENCIES. 107 

The laudanum and paregoric ought to be in bottles of an alto- 
gether different shape from those containing the other remedies ; 
and these, as well as the oil of cloves bottle, should be marked 
"Poison !" and have a tape or small ball and chain attached to their 
necks, so that it could be felt in the dark. Each bottle should have 
its proper dose plainly printed or marked on the label. 

DOSES AND USES OF THE MEDICINES. 

1. Ammonia. The aromatic spirits of ammonia — hartshorn — 
is a valuable remedy in cases of sick stomach, and even vomiting. 
It is also useful in cases of nervous or sick headache, as well as in 
simple nervousness. The dose is, for an adult, twenty-five drops ; 
for a child, ten drops, in about a wineglass full of water. This 
may be given every ten minutes, almost indefinitely. 

2. Asafetida. The tincture of asafetida is a nerve tonic, and 
also very soothing to the bowels. There is nothing better for 
causing expulsion of wind. The dose is, for an adult, a teaspoon- 
f ul ;' for a child, twenty drops in a tablespoonful of water. It can 
often be used as an injection when it could not be given by the 
mouth. In this case the quantity to be given is a tablespoonful 
for an adult and a teaspoonful for a child, in a small teacupful of 
warm water. 

3. Cloves. The oil of cloves is useful as a local application 
in toothache. It is also helpful in indigestion, in doses of three 
drops for an adult, and one drop for a child. It can be given 
rubbed up with a little sugar, or a teaspoonful of sweet oil. 

4. Hoffman's anodyne is useful in cases of hysterics and nerv- 
ous frights or chills. The dose is, for an adult, a teaspoonful in 
a wineglassful of water. Children rarely require medicines of 
this sort. But when they do, as is the case with certain high- 
strung children, half the dose for an adult may be given. 

5. Ipecac. The syrup of ipecac is a fairly good emetic. But 
it must be used freely. An adult should be given a good table- 
spoonful, and an infant, as near a teaspoonful as possible. It will 
do no harm, and when the emetic is called for, it is no time to run 
any risk that the dose given may not be large enough. It is often 
usefully employed in cases of poisoning, convulsions, croup, 
whooping cough or asthma. 

6. Laudanum. Laudanum is the tincture of opium, and has 



108 MEDICAL AND SURGICAL EMERGENCIES. 

all its properties. It is one of the most useful drugs in the world,, 
and yet it is a dangerous one. There need, however, be no fear 
of poisoning with any preparation of opium if ordinary doses are 
given, if these doses are not given closer together than half 
an hour, and if they are stopped as soon as pain is decidedly les- 
sened or drowsiness comes on. Occasionally small doses of opium 
cause great alarm, but there is much less fear about opium poison- 
ing among doctors now than there used to be. It may be consid- 
ered safe to give twenty-five drops of laudanum to any adult r 
when there is severe pain, and to repeat this dose every half hour 
until the pain is lessened or drowsiness begins to appear. One of 
the signs of the effect of opium upon the system is a contraction 
of the pupil of the eye, which does not expand in the dark. This 
ought always to lead to a discontinuance of any preparation of 
opium which has been used. 

To check diarrhea, sometimes, a drop of laudanum every hour 
will prove successful very soon. Yet, ten or fifteen drops may be 
given to an adult after each movement, if the smaller quantity 
does not suffice. 

For cuts and bruises there is no better application than pure 
laudanum. A soft cloth soaked in laudanum can be bound on, 
and occasionally wetted with it, without removal. It quiets pain 
and promotes healing. The same application is often very sooth- 
ing in face-ache, toothache and earache, as well as in the pains of 
rheumatism and neuralgia. (See "Paregoric") 

7. Magnesia. Magnesia is a mild remedy to open the bowels, 
usually employed for children. The dose being a teaspoonful, 
given in water or milk. It may also be used for sour stomach, 
when a pinch will generally be enough. 

8. Mustard. In the use of ground mustard for plasters, it 
should always be mixed with an equal part of flour. Even then 
it acts quickly and must be removed in a few minutes, as soon as 
the skin is well reddened. Where it is desired to leave a mustard 
plaster on for more than a few minutes, it should be made of one 
part mustard to three or more of flour. Every mustard plaster 
should be removed as soon as the skin becomes red, and not al- 
lowed to make a blister, because such blisters are excessively pain- 
ful and very hard to heal. 



MEDICAL AND SURGICAL EMERGENCIES. 109 

As an emetic, mustard is used by stirring a teaspoonful of the 
ground seeds in a teacupful of luke-warm water. 

9. Paregoric. Paregoric is an opium preparation which con- 
tains, besides opium and other things, some camphor. It is the 
best preparation for children, because the dose is easier to meas- 
ure than that of laudanum. An infant a few hours old will stand 
three drops and in a few days, five. In a month, ten are not too 
many, and twenty may be given any time after six months. An 
adult can take a tablespoonful. It may be used internally in all 
the cases where laudanum has been recommended. ( See "Lauda- 
num.") 

10. Rhubarb. The spiced syrup of rhubarb is an excellent 
mild laxative for the bowels. A teaspoonful is the dose for an 
infant or small child. It is useful at the beginning of a diarrhea 
in children, as it empties the bowels of what irritates them, and 
also has a soothing and healing influence. 

11. Turpentine. Spirits, or oil of turpentine can be used 
wherever mustard has been recommended as an external applica- 
tion. For this purpose a soft flannel or muslin cloth should be 
<iipped in turpentine, wrung out nearly dry, laid on the surface 
and covered with oiled silk or a few thicknesses of dry cloth, to 
prevent evaporation. 

Red pepper may sometimes be used instead of mustard, though 
it is more energetic in its action. When moistened and applied to 
the skin, red pepper first causes a feeling of warmth, and later of 
intense, fiery burning. If left on long enough, it will cause a 
blister. But this ought never be done. Red pepper may be used 
in cases of colic or cholera morbus, where it quiets pain by its 
counter-irritant effect, and stimulates the nervous and circulatory 
.systems. In nausea it sometimes does good by the latter process. 



DOMESTIC EMERGENCIES. 

Cholera Morbus — Colic — Vomiting, or Nausea — Diarrhea 
— Croup — Whooping Cough — Asthmatic Attacks — Nerv- 
ous Attacks — Toothache — Earache — Poisoning by the 
Common Poison Vine — Neuralgia oe the Face. 

No less important than the emergencies thus far considered, 
most of which have a public significance, are a few more which 
usually occur within the limits of the household and try the 
knowledge and patience of anxious parents. If these emergencies 
arose only when skilled assistance could be had in a moment, they 
might, perhaps, be omitted from a book like this. But they have 
a way of presenting themselves at the dead of night, in traveling, 
at the seashore, or in the mountains, where doctors are not known 
or are not to be had promptly, and those upon whom the burden 
of meeting them falls may be glad to have some simple sugges- 
tions as to what they may do until they can commit their interests 
to others better prepared to guard them. 

CHOLERA MORBUS. 

Cholera morbus produces vomiting and purging and violent 
cramps in the stomach. The pain may be so severe as to actually 
threaten life. There is then a pinched expression of the face, and 
a cool, clammy skin. In such cases, something must be done at 
once to relieve the pain. For this, laudanum may be given — half 
a teaspoonful to an adult, or ten drops to a child over twelve years 
old. At the same time heat must be applied to the stomach. For 
this purpose a mustard plaster can be used, or cloths wrung out 
of hot water and sprinkled with turpentine or with red pepper, or 
a hot- water bag, or bottle, or a plate heated at the fire and covered 
with a cloth. An injection containing a small teacupful of warm 
water or milk, to which a tablespoonful of tincture of asafetida 
has been added, often gives great relief. 

no 



MEDICAL AND SURGICAL EMERGENCIES, in 



couc. 

Colic causes violent griping pain in the abdomen. It usually 
is due to something indigestible which has been eaten. It should 
be treated by hot applications to the abdomen, such as have just 
been mentioned. A purgative, such as castor oil or ten grains of 
calomel may be given by the mouth, and an injection of water and 
asafetida administered, as described in speaking of cholera 
morbus. 

VOMITING, OR NAUSEA. 

Vomiting, or nausea, due to something objectionable in the 
stomach, may be treated by giving large draughts of fairly hot 
water. If it be due to nervousness or a slight indigestion, it can 
usually be corrected by swallowing small pieces of ice, or table- 
spoonful doses of lime water, or a pinch of soda, or half a tea- 
spoonful of aromatic spirits of ammonia in a wineglassful of 
water, together with the application to the pit of the stomach of 
a mustard plaster, or of a flannel cloth wrung out of hot water and 
sprinkled with a tablespoonful of turpentine or some red pepper. 
A lump of ice held against the pit of the stomach often does much 
good. The sufferer should always lie down until the nausea 
passes off. 

DIARRHOEA. 

Diarrhea is usually due to a cold or to something indigestible 
which has been eaten. In either case it is an effort of nature to 
cure itself of something hurtful. So, at the start, the best thing 
to be done is to give a mild purge. It is a good plan to give a 
teaspoonful or two of a mixture of equal parts of olive oil and 
castor oil to an infant, and a tablespoonful or two to an adult. 
Half these quantities of a mixture of glycerine and castor oil acts 
well. For infants nothing acts better than a tenth of a grain of 
calomel, given every hour or half hour till it produces a free move- 
ment. A small dose of equal parts of sweet oil and castor oil, or 
spiced syrup of rhubarb or magnesia is the best. After this, if 
the movements of the bowels soon return, half a teaspoonful of 
ginger in a wineglassful of water may be given to an adult after 
every passage. If this does not check the diarrhea, ten drops of 



ii2 MEDICAL AND SURGICAL EMERGENCIES. 

laudanum may be given to an adult after each passage. For an 
adult, also, an injection, made of half a small teacupful of boiled 
starch, to which thirty or forty drops of laudanum have been 
added, often gives immediate relief. For a child over two years 
old, half a drop of laudanum may be given after each passage, 
until the diarrhea seems checked, or there is some evidence of 
drowsiness. A simpler remedy, which often acts well, is a tea- 
spoonful of raw flour in a glassful of cool water, to be taken in two 
doses, half an hour apart. 

CROUP. 

Attacks of spasmodic croup, though very alarming, are 
rarely dangerous. There is probably much less real croup than is 
supposed, and the hoarse cough which children sometimes have 
after taking cold, may lead to measures which make it much worse 
for all concerned. Parents need not get excited when they hear 
what is called a "croupy" cough. When it occurs, they should 
see what can be accomplished by allaying the alarm of the child, 
and by diverting its mind. The reading of some favorite story 
or the exhibition of a favorite toy may cause all the symptoms of 
croup to disappear. 

When such mild measures are of no avail, and the symptoms 
become more urgent, the little sufferer should be given an emetic 
of a teaspoonful of syrup of ipecac or a heaping teaspoonful of 
powdered alum, followed by a draught of warm water. Cloths 
wrung out of water as hot as can be borne should be wrapped 
around the throat and laid upon the chest. They should then be 
covered with something to keep the heat in — like oiled silk or a 
dry cloth. 

This is all that can ordinarily be done with advantage till a 
physician arrives. But it usually gives decided relief. In this 
case, and even if it does not, natural anxiety should not drive par- 
ents to be wanting to do something else -all the time. They may 
renew the hot cloths as soon as they begin to grow cold, but beside 
this there is nothing to be done but to wait until there has been 
time for the spasm to pass off. This is hard to do, it is true ; but 
it is the best thing to be done, and far better than the fuss and 
worry, to parents and child, of trying a variety of methods. 



MEDICAL AND SURGICAL EMERGENCIES. 113 

In whooping cough there is a strong nervous element, and a 
spasm of whooping cough is often brought on by the example of 
another child. So, when a child is seized with a fit of coughing, it 
ought, if possible, to be at once separated from other children, for 
its own good and for theirs. Then, if the fit does not pass away in 
the usual time, it may sometimes be cut short by pressing a lump 
of ice against the chf 3t, or by placing hot cloths there. 

ASTHMATIC ATTACKS. 

Asthmatic attacks may be treated in several ways. One method 
is founded upon the fact that asthma is a nervous manifestation, 
which grows worse the more the attention is directed to it. If the 
attention can be diverted, the attack will often pass off. 

Occurring, as it usually does, at night, the darkness, the sur- 
prise, the absence of surrounding activities, increase its effects. If 
the sufferer be a man, and will get out of bed, put on his gown 
and slippers, light his gas and take a book or paper and begin to 
read, he will, in many cases, soon find his trouble diminishing and 
finally disappearing. If he be a smoker, his cigar or pipe will 
help him in this emergency. 

A less agreeable method is to take an emetic. Another is to 
smoke the asthma cigarettes sold in every drug store. Another is 
to get some steaming hot water in a basin, pour into it a table- 
spoonful or more of Hoffman's anodyne, and breathe the ascending 
vapors. One of the best remedies is a full dose of opium in some 
form — for an adult, thirty drops of laudanum, or a tablespoonful 
of paregoric. As soon as this takes effect, the spasm of asthma 
will disappear. 

NERVOUS ATTACKS. 

Nervous attacks, which may take the form of shivering fits, are 
to be treated by putting the patient to bed, if possible, and giving 
strong hot coffee, or hot sweetened water, and by applying heat 
to the body by a bath or hot cloths or bottles, with a mild mustard 
plaster or turpentine placed on the pit of the stomach. A tea- 
spoonful of camphor water, of valerian, or of Hoffman's anodyne 
will often prove of great service. 
8 



ii 4 MEDICAL AND SURGICAL EMERGENCIES. 

TOOTHACHE. 

Toothache, depending upon a cavity in a decayed tooth, is 
usually very easy to stop. To do this, a fine crochet needle should 
have a very small bit of clean cotton twisted round its point, and 
with this, the hole in the tooth should be thoroughly swabbed out. 
Then the point of the crochet needle should be cleaned and another 
little ball of cotton, like a very small shot, should be dipped in oil 
of cloves and caught up with the end of the needle. It should 
then be laid in the hollow tooth and pushed in, not too hard, with 
the end of the needle. This rarely fails to relieve such a toothache. 
Sometimes filling the cavity with baking soda will stop the pain. 

When toothache is not due to a hollow tooth, a somewhat severe 
but usually efficient plan of treatment is to lay between the gum 
and cheek a little wad of cotton, the size of the end of the thumb, 
soaked in spirits of camphor. This makes a sort of blister, but 
generally cures the toothache, which is much harder to bear. 

EARACHE. 

Earache should always suggest an examination of the teeth, and 
if one be found decayed, it must be extracted or at least cleaned 
out and packed with cotton and oil of cloves, as described in speak- 
ing of toothache, for many earaches depend upon diseased teeth. 

In case this is not called for, or does no good, a folded cloth, 
wrung out of hot water, with a teaspoonful of laudanum poured 
over it, or a big, hot poultice — for which hops is the best material 
— should be applied to the side of the head and kept as hot as 
possible. Hot drinks should be given also, and enough laudanum 
to cause relief from pain. 

The occurrence of an earache should always lead to consulting 
a doctor, for it is often of importance as a sign of disease which 
may seriously affect the hearing. 

POISON vine. 

Poisoning by the common poison ivy vine causes red blotches, 
and wheals, and blisters on the skin, with great burning and itch- 
ing. It is best treated by applying cloths soaked in a solution of 



MEDICAL AND SURGICAL EMERGENCIES. 115 

soda, a teaspoonful to a teacupful of hot water. Dusting with 
magnesia or ordinary toilet powder is also grateful. 

neuralgia. 

Neuralgia of the face may come on suddenly, when the advice 
of a physican cannot be obtained. In such a case, the application 
of a hot cloth, wet or dry, may do much good, or painting the pain- 
ful part with oil of peppermint. On the other hand, cold applica- 
tions may do more good, although this does not often happen. 



FRACTURES OF BONES AND DISLOCA- 
TIONS OF JOINTS. 

Causes of Broken Bones — Variety of Fractures — Symptoms 
of Fractures — Treatment of Fractures — Dislocations of 
Joints. Dr. Lorenz' Methods — Causes of Dislocations — 
Prominent Symptoms — Treatment of Dislocations. 

The human body is built upon a bony frame-work held together 
by muscles and ligaments, and like other superstructures, when 
the foundation gives way, the rest is rendered useless to a greater 
or less extent, for a time at least. 

The aid required of a nurse in the case of a broken bone, de- 
pends largely upon the complications arising because of the frac- 
ture, or the means by which the fracture was produced ; thus a so- 
called simple fracture of the leg, produced by a fall, would require 
very different management on the part of the nurse than the 
fracture of the leg due to a gun-shot wound, and so-called 
joint fracture, or the fracture of a leg by a sharp instrument, in 
which the soft parts, muscles, nerves and blood-vessels are injured. 

In the simple fracture of a leg, the nurse is only required to put 
the part at rest, apply cold or heat, and await the surgeon's ar- 
rival ; whereas in the fracture of a leg with an internal wound of 
the soft parts, her first duty may be to stop hemorrhage or apply 
an aseptic or antiseptic temporary dressing, or perhaps more often 
to stop hemorrhages and apply a temporary dressing at the same 
time, and then await the surgeon's arrival for further instructions. 

CAUSES OF BROKEN BONES. . " 

Internal violence or intense muscular contraction may cause 
fracture of bones. The bone may give way immediately at the 
sight of violence, for example, a wagon wheel going over a leg 

116 



MEDICAL AND SURGICAL EMERGENCIES. 117 

or thigh, the bone giving 'way immediately beneath the wheel. 
Fractures may also occur by transmitted violence; for instance, 
patient may fall with arms extended, and the hands extended on 
the fore arms, or with the hand extended, and yet it may not be the 
bones of the wrist that give 'way, but one or both bones of the 
fore arm, as occurs in persons who accidentally stumble, and in 
order to protect themselves, put one or both hands out, the whole 
force of the fall being received by the extended hand; as a 
result, the bones are fractured, and also some part of the arm other 
than the hand. 

VARIETY OF FRACTURES. 

There are many divisions of classifications, among the most 
common forms are the simple, complete and incomplete, com- 
pound, complicated, mixed, and green stick; the latter variety is 
found in children in which the bones are not fully developed, also 
those within joints, such as the shoulder and hip. Fractures may 
be known by what is called transverse, where the bone is broken 
directly across, or they may be oblique, where the bone is broken 
and the fracture extends quite a long distance along the bone. 

SYMPTOMS OF FRACTURE. 

Pain is a very common symptom, as in all fractures there is 
some pain. Deformity is also present in all fractures where the 
bones are broken across. Just as soon as the bone is broken, the 
muscles of the part are thrown into a condition of spasm or con- 
traction. By these spasms or continued contraction, the broken 
ends of the bone are pulled together, one upon the other. In other 
words, the broken ends of bone override each other, and thus pro- 
duce deformity, loss of function and increased motion, or un- 
natural movement is also experienced, and there is generally 
where the bones are broken across, by rubbing the two ends to- 
gether, a grating sound, which can be transmitted to the examin- 
ing surgeon's hand and ear. Swelling of the parts develop soon 
after fractured, and it may be severe; where the bones are frac- 
tured in many places, it is known as a compound fracture, and is 
a more serious form. 



n8 MEDICAL AND SURGICAL EMERGENCIES. 

TREATMENT OF FRACTURES. 

There is nothing of importance which may be said in this work 
which would be of very great benefit as to treatment, as it is 
enough to know that a fracture is present, and that services of a 
surgeon are an absolute necessity, and that the services be secured 
as expeditiously as the circumstances will warrant. 

DISLOCATIONS OF JOINTS. 

Dislocations or luxations, as commonly understood, are the 
separations of joints, and may be divided much as are fractures. 
The bones of the human body are joined together and kept in posi- 
tion by ligaments, arid the ligaments are of different size and 
shape, thus some are broad, some are long, etc. They are so 
formed as to afford protection and strength to the joint. 

CAUSES OF DISLOCATIONS. 

The cause of dislocations may be lack of proper development, 
as is well illustrated in congenital dislocations of the hip, the 
child being born with an abnormal hip joint articulation. The 
Lorenz operation for the deduction of congenital dislocation of 
the hip, Dr. Lorenz being the professor of orthapedic surgery in 
the University of Vienna, is receiving attention from the medical 
profession all over the United States. The cause of this is the 
bringing of Dr. Lorenz to this country to operate on a child of a 
Chicago millionaire, who was born with a congenital dislocation 
of the hip. In this form of dislocation of the hip, instead of being 
in its natural place or cavity in the joint, the head of the femur is 
found outside. Consequently it is impossible for the hip joint to 
move. Dr. Lorenz has succeeded in reducing the dislocation by 
putting the bone back into the place where nature should have left 
it without any surgical operation, and by manipulations, rest and 
treatment he has succeeded in making a useful joint in what would 
otherwise be useless throughout life. 

As with fractures, the long bones of the upper extremities are 
more often the seat of dislocations than are other bones of the 
body. 



MEDICAL AND SURGICAL EMERGENCIES. 119 




Fig. 15. Hip joint. No. 1, head; 2, acetabulum; 3, pubes. 



PROMINENT SYMPTOMS. 

The prominent symptoms of dislocation are deformity, pain, 
swelling, loss of function, and instead of increased mobility as in 
fracture, the part is fixed. It is well to remember that a fracture 
may occur in any part of the bone, but a dislocation appears only 
at the joints. 



120 MEDICAL AND SURGICAL EMERGENCIES. 

TREATMENT OF DISLOCATIONS. 

The most important thing to bear in mind in relation to the 
treatment is that the sooner surgical aid is obtained the better, 
and the less trouble there will be in putting the bone back into 
place, the less danger there will be of complications. The neces- 
sity for bandages, splints and dressings will, of course, adjust it- 
self to those who have the case in charge. 



VOMITING. 

Cause: and Treatment, Prescription for — Hiccough, Causes 

and Treatment. 

Vomiting is, of course, a symptom, not a disease, and rises from 
a large number of causes, some of which are very unimportant, 
and others very serious. The most frequent cause is improper 
food and improper digestion. Other causes are located in the 
brain, and may be due to hemorrhages in the brain, and inflamma- 
tion of the covering of the brain, or of the brain itself, or a poi- 
soned condition as in uremia. All of these conditions cause an 
irritation of the part of the nervous system which controls vomit- 
ing, and are serious conditions. 

It is important to bear in mind that vomiting due to disorder of 
the walls of the stomach may depend upon either of two condi- 
tions. The mucous membrane of the stomach and its nerves, may 
be over-excitable, or the opposite condition may exist, and it may 
be depressed. For this reason, it will be understood that two 
modes of treatment are necessary. Sometimes a prescription of 
the following substances is of great service in allaying the ex- 
citable condition of the stomach : 

Subnitrate of bismuth, 2 drachms. 

Bicarbonate of soda, 6 drachms. 

Make into twelve powders ; take one every two hours. 

In other cases, if the vomiting is severe, and there has been 
much fermentation of food, the following will be of value : 

Carbolic acid, 3 drops. 
Bismuth of subnitrate, 3 drachms. 

Make into ten powders, taking one every two hours until there 
is some improvement. 

121 



122 MEDICAL AND SURGICAL EMERGENCIES. 

In other cases, where there is a weakness in the stomach, due 
to feeble digestion, the following will be found useful : 

Tinct. of nux vomica, 10 drops. 
Cinnamon water, 2 ounces. 

Take a teaspoonful every four hours. In all cases of persistent 
vomiting, counter irritation should be applied over the stomach 
in the form of a mustard plaster, or, if preferred, an ice-bag may 
be put at the back of the neck or along the spine. Food given at 
this time should be very carefully prepared. The white of an egg 
with a little lemon added will be found grateful, also milk with a 
little lime water added. Another important point to observe is 
not to give much at a time, but give in small amounts frequently. 

HICCOUGH. 

This is an affection arising from many causes, depending upon 
irritability of the nerves supplying the diaphragm, as a result of 
gastric irritation, nervousness, uremia, and is a complication of 
several exhausting diseases, such, for example, as typhoid fever. 

Hiccough is produced by the sudden ascent of the diaphram, 
whereby a vacuum is formed in the chest, into which the outside 
air attempts to rush, but is prevented from doing so by the sud- 
den closure of the windpipe. The peculiar sound of the hiccough 
is thus developed. Generally the symptom stops of its own accord, 
but it may become continuous and excessive. The remedies to be 
applied are used according to the cause of the disorder. Some- 
times it is due to taking too much acid into the stomach, and some- 
times the opposite condition exists. In cases where the effection 
comes on after meals and is due to indigestion, a course of tonic 
treatment will often give relief. The following prescriptions have 
been found useful : 

Bicarbonate of soda, 1 drachm. 

Tinct. of nux vomica, 1 drachm. 

Tinct. cardamom, 2 ounces. 

Take a teaspoonful before meals in half a glass of water. 



MEDICAL AND SURGICAL EMERGENCIES. 123 

INDIGESTION AND BILIOUSNESS, WITH PRESCRIPTIONS FOR SAME. 

Biliousness is a common condition, causing not a little suffer- 
ing, and is due to a number of causes. It is always a symptom, 
not a disease in itself. It often occurs during a course of short or 
prolonged fevers, from weakness in the walls of the stomach, and 
lack of secretion of the proper character — or there may be too 
much secretion of the wrong kind in the stomach, thus causing a 
fermentation or changes in the food as a result. Sometimes it is 
due to inflammation of the stomach. Course of treatment must 
depend upon the cause; if the latter can be determined, it must 
be removed. 

Biliousness, or indigestion, attended by a course of fevers, can 
nearly always be avoided by proper diet, and the use of pre- 
digested foods, such as beef tea, milk, and broths. For the method 
of preparing foods for different diseases, the reader is referred 
to the articles under that head. 

In those cases in which the dyspepsia results from imperfect 
mastication of food, it is evident that careful eating rules are to 
be given the patient, with the additional advice, which is equally 
good in all cases, that exact meal hours should be adhered to, since 
irregularity in eating results in imperfect digestion. If it is found 
that there is a distress after eating, it indicates that there is a feeble 
digestion, and remedies to tone up the stomach are indicated, such 
as the following: 

Dilute hydrochloric acid, 1 drachm. 

Fluid extract of condurango, \ ounce. 

Compound tincture of cardamom, 3 ounces. 

A teaspoonful to be taken after meals, in a wineglassful of water. 

Sulph. soda, 1 ounce. 

Tartrate of sodium and potassium, 1 ounce. 

Infusion cascarilla to make 8 ounces. 

Take two (2) tablespoonfuls three times daily. 

* : 

Dilute nitro-muriatic acid, 1 ounce. 

Take 10 drops in half-glass of water before meals. 



VERTIGO. 

Definition — Causes — Symptoms — Treatment. 

Definition. Vertigo or dizziness is a state in which the indi- 
vidual affected, or the objects about him seem to be in rapid mo- 
tion, either of a rotary, circular, or a to-and-fro kind. 

Causes. The different forms of vertigo depend upon the cause. 
Vertigo, which may be traced to the eyes, may be caused by eye 
strain or paralysis of one or more of the muscles of the eye. 
Another form may be due to diseases of the ear, or what is com- 
monly known as Meniere's disease, which is located in the internal 
canals of the ear. This disease properly so called, is a sudden, 
severe, purulent exudation into the internal canals. Vertigo due 
to some abnormal condition of the stomach is the most frequent 
variety, and results from either dyspepsia of the stomach or in- 
testines, or disordered liver, or constipation. The method by 
which vertigo is caused is complex. There are two factors in its 
production, one is a poisonous effect of some material being re- 
tained in the system, which ought to be eliminated, and which ac- 
cumulates in the blood, and thus passes to the brain ; the other is a 
reflex act, an impression being made on the ends of the nerves, 
for instance, those which line the stomach, and is reflected back 
to the brain. Nervous vertigo is associated with migraine, sick 
and nervous headache, and is caused by physical or mental ex- 
cesses, also by the immoderate use of tea, coffee, or tobacco, and 
many other exciting causes as a result of excesses of any kind 
which disturb digestion and the circulation of the blood. 

Symptoms. The attacks of vertigo appear at regular intervals, 
the individual being comparatively well in the periods between 
the paroxysms. For a day or two preceding the attack it will be 
ascertained on close examination, that there was a feeling of 
fatigue without apparent cause, heaviness over the eyes, with 
some gas in the stomach, and indigestion. The attack proper is 

124 



MEDICAL AND SURGICAL EMERGENCIES. 125 

ushered in by chilliness, nausea, and often vomiting, yawning, and 
general muscular soreness, with incapability for mental exertion. 
The patient suffers frequently from pain of a sharp, shooting char- 
acter of great intensity and persistency, located most frequently 
either on the back of the head, or on the front ; at the same time 
there is often a tenderness over the whole head. Rarely is the pain 
felt on the right side, and still more rarely on both sides at the 
same time. Nausea and vomiting may follow the onset instead 
of preceding the pain. There is more or less disturbance of the 
circulation, temperature and secretion of the affected parts. At 
times there is marked contraction of the vessels, when the face is 
pale, the eyes shrunken, and the pupils dilated; again the face is 
flushed, the conjunctives injected, and the pupils are contracted. 
These symptoms are so characteristic that error seems impossible, 
although it may be confounded with an anemic headache, hyper- 
emic headache, a dyspeptic or bilious headache, and neuralgia, 
or rheumatic headache. While a few cases of vertigo are perma- 
nently cured, the affection is not very often dangerous to life. In 
quite a number of cases the attacks grow less frequent as the per- 
son advances in years, it being rarely seen after fifty years of age. 
Treatment. All forms are generally due to the result of bad 
nutrition or functional disorder. If due to indigestion, of course 
remedies must be used to correct this disorder, and the reader is 
referred to the remedies under that heading. If due to nervous 
condition, remedies can be used to correct the error in the nervous 
system. For the latter, the following prescription has been found 
useful : 

Potassium bromide, 4 drachms. 
Potassium bicarbonate, 4 drachms. 
Water, 3 ounces. 

A teaspoonful of this may be taken every three hours. Local 
applications to the head, of cold and hot water used alternately, 
or whichever seems to give the most relief, will also be found 
grateful. 



LOCOMOTOR ATAXIA. 

Symptoms — Treatment. 

This is a disease of the spinal cord. It begins, and may be 
confined to the posterior columns of the cord, sometimes affect- 
ing part of the cord, other times the whole length of the cord, and 
also of the different columns of the cord. The spinal cord takes on 
a hardened condition, and the condition may extend to the nerves 
of the arms and limbs. It is generally divided into three periods : 
First, disturbances of sensation ; second, loss of power to use the 
limbs properly; third, paralysis. 

The onset of the disease is gradual, and with sharp, darting 
electric-like pains in the lower limbs, with disorders of the gastro- 
intestinal and genito-urinary tracts ; associated with the pains 
and loss of sensation in the feet, the patient being unable to dis- 
tinguish between hard and soft substances in walking, and if the 
upper portions of the spinal cord be affected, is unable to control 
the muscles of the fingers sufficiently to button his clothing. The 
sensation of formication over the surface, especially over the lower 
limbs, and about the waist, the knee, and the ankle ; loss of power 
to control the muscles, the subject being unable to walk upon 
a straight line with the eyes closed, and with difficulty if the eyes 
are open; inability to preserve the erect position with the feet 
closed together ; and as the malady progresses, he throws his feet 
and legs in a most grotesque manner. Although the patient is 
unable to control the muscles, their power is not lost, for, on being 
supported, he can kick and strike with his usual force. 

The sight is early impaired ; either double vision, or inability to 
distinguish between different colors. As the disease progresses, 
the sensation becomes more and more blunted and pain is slowly 
felt, in cases it being several minutes before the sticking of a pin is 
felt. The characteristic sign of the disease is the abolition of the 
patella tendon-reflex, as well as other reflexes in the lower limbs. 

126 



MEDICAL AND SURGICAL EMERGENCIES. 127 

The electro-contractility is decreased in the affected limb. General 
emaciation is marked. 

Few, if any cases, entirely recover, although progress may be 
retarded for a long time, and if treated early in the disease, some 
genuine cures appear to have taken place, but when it passes on 
into the second stage, the prospects for a cure are very uncertain. 

Treatment. Various remedies have been used; various forms 
of gymnastic exercises have also been utilized. Remedies for re- 
lief of pain, which are very annoying and exasperating to the 
patient, are called for. The following for this purpose is probably 
one of the best that can be secured, and the dose given should be 
a tablespoonful night and morning: 

Exalgine, 30 grains. 

Whisky, J ounce. 

Simple syrup, 1 ounce. 

Water enough to make 4 ounces. 

The following prescription is also found beneficial where there 
are spasms of the muscles of the throat, or any other parts of the 
body: 

Potassium bromide, 2 drachms. 
Ammonium bromide, 4 drachms. 
Spirits ammonia aromatic, 6 drachms. 
Camphor water enough to make 5 ounces. 
A dessert spoonful in water every four hours. 



PULMONARY CONSUMPTION, OR CON- 
SUMPTION OF THE LUNGS. 

The Tubercular Bacillus — Symptoms of Consumption — 
Treatment — Climatic Treatment. 

The air cells of the lungs are the seat of that very interesting 
disease known as phthisis pulmonalis or tubercular consumption. 
This terrible disease, like a pale and withering pestilence, is esti- 
mated to destroy no less than one hundred thousand human be- 
ings every year in the United States alone. But it does not prey 
upon the poor, uneducated classes only, but it claims its numerous 
victims among the noblest, most gifted, highly educated and re- 
fined classes of society ! 

In this disease, tubercular deposits are formed in all of the tis- 
sues and organs of the body, but more often in the cavities of the 
.air cells of the lungs, filling them full of gray, or yellow cheesy 
matter, causing short and imperfect respiration. In perfect health 
the air cells of the lungs are open and empty, like the cells of 
empty honeycombs, to receive the air every time we breathe, and 
in this condition the lungs weigh only from one to three ounces. 
•On this account the lungs are often called lights. 

THE TUBERCULAR BACILLUS. 

It is now generally conceded that the ultimate cause of tuber- 
culosis is the tubercle bacillus, as first determined by Koch in 
1882. This is a slender rod, varying in length from J to -J the 
diameter of a red blood corpuscle ; it is straight or curved, occur- 
ring singly, in chains or in groups, and is incapable of voluntary 
motion. When properly stained, it has a peculiar, beaded appear- 
ance, and if highly magnified, small bright spots may be seen with- 
in the rod, having the appearance of spores. The bacilli are rela- 
tively enduring, but grow outside the body under the most careful 

128 



MEDICAL AND SURGICAL EMERGENCIES. 129 

regulation of temperature, nutrient media, and other conditions. 
Tubercle bacilli enter the lungs chiefly through the air passages, 
being conveyed by particles of dried phthisical sputum or dust. 

THE SYMPTOMS OF CONSUMPTION. 

The symptoms of ordinary pulmonary consumption are well 
known to everybody, especially when the disease becomes well 
advanced — the hawking cough, the progression of emaciation, the 
expectoration of blood, the purulent sputum from the lungs, the 
hectic flush of the cheek, and the night sweats of this dreadful dis- 
ease, are prominent symptoms. 




Fig. 16. Trachea, bronchial tubes and air cells, showing tubercular deposits. 

TREATMENT. 

It must be very evident to everyone who is at all familiar with 
the cause and conditions existing in this disease, that filling the 
cavity of the stomach with vile nostrums and compounds will not 
contribute in any sense toward the cure or even staying the prog- 
ress of this dread disease. Diet and temperature will do more than 
9 



i 3 o MEDICAL AND SURGICAL EMERGENCIES. 

all remedies which are known to the medical profession at the 
present time. 

There is no disease which requires a more careful regulation 
of the diet than consumption, and the conditions of the stomach 
and organs of digestion should be as carefully attended to as the 
condition of the lungs, in order to ascertain just what kind of food 
agrees best with each individual case of consumption, for it will 
soon be ascertained that the kind of food which agrees best with 
one case, will not agree with another. 




Fig. 17. Showing tubercular disease of the lungs. 



Heavy, indigestible foods must be avoided. As a general rule, 
raw beef, cut in very thin slices, not thicker than a wafer, will 
digest much quicker than cooked meat. It may be eaten freely 
three times a day with good coarse, stale, wheat bread, and cream 
and butter. The diet should be very simple and nourishing, and 
consist of only one or two kinds of food at a time. The stomach 
is often injured by eating a great variety of food at the same 
time. No habit can be more pernicious to the consumptive. Care- 
fully abstain from the use of dried or baked meat. These methods 
of cooking meat only harden its fibre, and render it more insolu- 
ble -and indigestible. 



MEDICAL AND SURGICAL EMERGENCIES. 131 

Many an unhappy consumptive has perished while trying to 
digest fried meat soaked in grease. When human beings can eat 
and digest such food, they do not need to have a doctor — but 
plenty of wood to chop. 

CLIMATIC TREATMENT. 

Medical symptoms will be greatly benefited by suitable climatic 
influences. In the first place, I believe that the patient's chance 
of recovery will improve from fifty to seventy-five per cent, by 
residence in a suitable climate; in the second stage, from fifteen 
to thirty per cent. ; in the third stage, a small percentage will be 
permanently benefited, and in a large proportion of others, life 
may be considerably prolonged. 

There is no place to which consumptives may be sent indis- 
criminately, but suitable places should be selected for each patient. 
Some patients feel better in cold weather, but the majority feel 
better in summer. In the earlier stages warmth is not so impor- 
tant providing there is an abundance of sunshine and dry tempera- 
ture to be obtained, and for such patients the southerly latitude in 
winter is most suitable. In this country, the high altitudes of 
Colorado, Wyoming, Montana and Utah afford a typical climate 
for those cases, whereas in winter they generally do better in New 
Mexico, Western Texas and Arizona. Those for whom the high 
altitude of two or three thousand feet is preferable, will do well 
in summer in some parts of Dakota, Nebraska, and Minnesota, or 
in the Adirondacks, or the mountains of Virginia, North Carolina 
and Tennessee. In winter more suitable climates are found in 
warmer latitudes, as Tennessee, North Carolina or Georgia. The 
medicinal treatment must depend upon the condition of the patient 
and subject of the disease. 

The amount of nutrition taken into the system must only be 
limited by limit of assimilation. Thus agents which will supply 
to the largest possible extent the waste which is repeatedly going 
on have been found the most useful remedies to alleviate the 
cough, and give the patient rest, and will be found among the 
formulas given for this and other diseases. 



CATARRH OF THE RESPIRATORY TRACT, 
ACUTE AND CHRONIC. 

Acute and Chronic Nasal Catarrh — Causes and Symp- 
toms — Treatment, Prescriptions for Internal and Exter- 
nal Use. 

Diseases of the nasal passages. These include the different 
forms of catarrh, both acute and chronic. The acute frequently 
takes the form of a cold in the head. It is an acute catarrhal in- 
flammation of the mucous, or lining membrane of the nose and 
throat. It generally begins with a fever and a feeling of fulness 
and discomfort in the head, with a discharge of fluid, watery 
mucus, and as the disease advances, the discharge takes on a 
thicker character. 

Chronic nasal catarrh is a chronic inflammation of the same 
parts as the acute, with a more or less alteration of structure ac- 
companied by a sensation of fullness in the nares, also increased 
secretion, and very often the special senses of smell and hearing 
become affected. 

Causes. Atmospheric changes are the most frequent. Expos- 
ure of the neck and head to draft or cold air, or of the feet and 
ankles to cold and dampness, and change from very warm to cold 
temperature suddenly, are among the most usual causes, also irri- 
tating gases and vapors, dust and powders, exciting an irritation 
of the nasal mucous membrane. Those inheriting a scrofulous 
condition or a rheumatic tendency seem to be more liable to fre- 
quent attacks. The extension of a catarrhal inflammation fre- 
quently occurs passing up the Eustachian tube from the throat to 
the ear, causing impaired hearing. 

Symptoms of chronic form. A feeling of fulness in the nose, 
increase in secretion, its character being thick and greenish, 
which, dropping posteriorly into the throat causes paroxysms of 

132 



MEDICAL AND SURGICAL EMERGENCIES. 133 

hawking, which are more marked in the morning immediately 
after rising. The special sense of smell is frequently impaired, 
and in case of long standing, is entirely abolished ; the hearing be- 
comes affected, although to a less extent; the voice also is im- 
paired, and frequently a dull frontal headache exists. The inflam- 
mation frequently extends to the nasal duct, thereby causing ob- 
struction to the tears, making them flow over the side of the face, 
instead of passing down through the natural channel into the nose. 
Treatment. Both forms. Prescriptions will be given, together 
with the method of using them, under the head of ''Treatment for 
the Respiratory Tract." 

Tincture aconite root, \ drachm. 
Tincture belladonna, 1 drachm. 
Water enough to make 2 ounces. 

Take one teaspoonful every three hours at the beginning of 
cold, for adult. 

The following will be found useful as a gargle or spray by an 
atomizer three times a day for catarrh of nose and throat : 

Glyco-thymoline, 2 ounces. 



ASTHMA. 

Definition — Causes — Treatment. 

Definition. The paroxysmal, spasmodic contraction of the mus- 
cular layers of the small broncjiial tubes, characterized by the spas- 
modic attacks of distressing, expiratory breathing, continuing for 
hours, days, and sometimes for weeks. 

Causes. In many cases it is clearly a nervous condition, and as 
a result, the respiratory apparatus is affected. Quite fre- 
quently it is hereditary, some members of the family suffering 
from asthma, others from some nervous trouble. Patients are 
great sufferers; coming on frequently at night, irritating sub- 
stances will often provoke a violent attack, as also atmospheric 
changes. 

The paroxysm begins, in the majority of instances, in the early 
morning hours, or during the afternoon, with a feeling of anguish 
and constriction in the chest, and an intense desire for air. The 
breathing is accompanied with loud wheezing; the face is flushed, 
at times even cyanosed, and bathed in perspiration, the eyes star- 
ing, the eyeballs protrude, and the muscles of the neck become 
prominent as they aid in the effort for air. The difficulty in breath- 
ing soon becomes so severe that the inspiration is but a gasp, the 
lips are pallid, cyanosis deepens, and the patient feels as if death 
were impending. Owing to the tonic contraction of the smaller 
bronchi, the air drawn into the bronchial tubes escapes imper- 
fectly, resulting in the difficult expiration. 

After some minutes or hours, the respiration becomes easier, 
the air in the lungs changes, the cyanosis disappears, and gradually 
the paroxysm ceases, the patient being exhausted and the chest 
fatigued. The duration of an attack varies from one to many 
hours, or often days, instead of single attacks. Still, remissions 
may occur at intervals of one, two, or three hours, and be followed 
by another attack lasting from four to six hours, continuing for a 

134 



MEDICAL AND SURGICAL EMERGENCIES. 135 

week or two, preventing the patient from lying down or taking 
food. 

Asthma, in itself, is not fatal to life, but if the paroxysms are 
frequently repeated, there results a change in the air cells in the 
lungs, enlarging them, and rendering respiration very difficult, 
and if the condition lasts long enough, there are changes in the 
heart. Indeed, the attack often occurs and complicates diseases of 
the lungs, of the heart, and also of the kidneys. 

Treatment. Asthma generally attacks those of lower vital- 
ity, therefore a tonic is indicated. In many cases, nothing but a 
change of climate will give any relief. For medical treatment, 
prescriptions will be given which will give temporary relief, and 
will therefore be very grateful to the patient. 

Cigarettes made of paper soaked in nitrate of potassium may 
be smoked. 

Grindelia Rodusta may be given in the dose of 10 to 30 drops 
of the fluid extract, three times a day. 



DISEASES OF THE HEART. 

Treatment — Palpitation of the: Heart, or Irritable Heart 
— Definition — Causes — Symptoms — Treatment — Angina 
Pectoris, or Neuralgia of the Heart— Definition — 
Causes — S ym pto m s. 

The heart, being the central organ, and the one which is re- 
sponsible for the circulation of the blood, is a very important 
organ, and one which may become diseased similar to any other 
part of the body. The heart, as you will observe by studying 
the article under the head of physiology, is covered by two mem- 
branes. Within these membranes is a fluid. Membranes are 
supposed to be for the protection of this organ, and the fluid is to 
lubricate and prevent frictional or grating conditions which are 
liable to occur, and which do occur when these membranes be- 
come diseased. Among the most common affections of this organ 
and its membranes is inflammation, both acute and chronic, of 
the pericardium, which is the outside membrane of the heart, and 
the endocardium, which is the inside membrane. Then again, the 
heart itself may become diseased from inflammation and other 
causes. The heart itself may become enlarged from an overgrowth 
or increase in the muscular walls of the heart. Then again, we 
have a stretching of the walls of the heart, which interferes with 
the heart beat, consequently circulation in different parts of the 
body is more or less interfered with also. Dilatation of the heart 
is frequently due to overexertion as occurs in the use of violent 
athletic sports, and it may be caused also from diseases of the 
lungs and of the kidneys. Then again we have what is known as 
the fatty condition of the heart, in which the muscular walls are 
turned into a fatty condition, and as a consequence, the action of 
the heart is very much weakened, and the breathing is labored and 
difficult as a result. 

This condition of fatty heart often occurs in elderly people, also 

136 



MEDICAL AND SURGICAL EMERGENCIES. 137 

in prolonged anemia, chronic gout and alcoholism. Then again, 
we have a disease of the valves of the heart, which is also very 
serious, and which needs the closest attention of an experienced 
physician just as soon as any symptoms of this nature develop. 
Treatment. As to treatment of the above conditions, it is im- 




Fig. 18. No. 1, the heart and pulmonary artery; 2 and 5, lungs; 3, larynx; 
4, aorta; 6, superior vena cava. 

possible to lay down any line of treatment which should be fol- 
lowed, as each case and each condition must be determined at the 
time and suitable remedies be procured by some one who is capa- 
ble of doing so, the heart being too important an organ, and one 



138 MEDICAL AND SURGICAL EMERGENCIES. 

which must be carefully dealt with. In many of the above condi- 
tions, if a remedy were given to accelerate its action, it would 
seriously aggravate its condition, while, on the other hand, reme- 
dies given to impair the action might also have a serious result. 

PALPITATION OP THE HEART, OR IRRITABLE HEART. 

Definition. Many people suffer from this condition at some 
period of their life. It is a functional disturbance of the heart, 
characterized by increasing heart-beat, and frequently some irreg- 
ularity in the beat also. 

Causes. Overexertion, dyspepsia, uterine diseases, excessive 
use of tea, coffee, tobacco, alcohol, and any form of dissipation are 
liable to bring on this condition. Intense anxiety and fear will 
also cause it. 

Symptoms. Usually palpitation of the heart is a sudden onset 
after some one of the causes mentioned, precordial oppression or 
pain, rapid, tumultuous beating, the impulse being visible through 
the patient's clothing ; dyspnea, anxiety, and the sense of choking 
or fulness in the throat, the recumbent position impossible, 
vertigo, faintness, flashes of light, the pulse full and strong or 
feeble, the face flushed or pale, the patient having a feeling of 
anxiety, with a sense of impending danger, and a fear of sudden 
death. These attacks are paroxysmal, lasting from a few moments 
to several hours or a day, the patient having a large quantity of 
limpid urine after the paroxysm has subsided, when there is a 
strong tendency to sleep. 

Treatment. The treatment must depend upon the cause. If 
the person is run down and anemic, of course the indications are 
to build up the system ; give remedies to make more blood, while 
on the other hand, if the palpitation is due to dissipation, or excess 
in eating or drinking of any kind, the indications are to regulate 
this. 

HEART FAILURE OR "BROKEN HEART."" 

The list of those who die from what is popularly known as 
"heart failure" is a long one. In almost every disease organic in 
its nature, and which is severe enough to cause death, when the 
heart begins to fail and ceases to pulsate the unavoidable result 



MEDICAL AND SURGICAL EMERGENCIES. 139 

must follow : the blood, instead of being forced out into the vessels 
and into all parts of the body, including the lungs, will become cold 
and then the suffering person experiences shortness of breath and 
difficulty in breathing. The blood is dammed up in the heart, the 
heart becomes overloaded, the pulsations become weaker and 
weaker, slower and slower, until it stops, and this, in very many 
cases, is the immediate cause of death. 

Heart disease from worry and mental strain. There are many 
suffering extreme agonies from heart disease, induced by a severe 
mental strain. We find it occurring in four classes of our com- 
munity; first, the persons engaged in art, science or literature; 
second, in those who are engaged in political life; third, in those 
who are occupied in commercial transactions and worrying 
speculations ; fourth, in women who have suffered exhaustion from 
many diseases peculiar to their sex and marriage relations. 

Heart disease due to mental strain is caused by the nerve supply 
of the heart becoming exhausted, which condition is familiarly 
known as a "broken heart." This term does not imply an actual 
rupture or a bursting of the heart, although this extreme accident 
may happen, and cause immediate death; a case is reported of 
Philip V., of Spain, who died, according to his historian, upon 
hearing of the defeat of his army, but this condition is of rare 
occurrence. 

All hearts are not built equally strong to bear physical fatigue. 
We say of some individuals: "They are lion-hearted," and of 
others : "They are faint-hearted." Physical courage depends upon 
the strength of the heart. In entering a school we find invariably 
two classes of boys: cowards, so-called, who never fight, and 
another class more valiant, who are always ready to fight, even 
to death. The nervous boys very often have weak hearts, the 
valiant boys strong hearts. The first may become, in time, by far 
the more powerful, intellectually, but the latter are very liable to 
excel in physical prowess and carry on the industries of the world. 

A person suffering from what is commonly known as "broken 
heart" is in a very deplorable condition ; I have known business 
men who have been moderately successful in business, and have 
arrived at the age of fifty, but have met business reverses and seen 
their hard-earned gatherings of all their former life swept away, 
and have, notwithstanding, made heroic efforts to again establish 



i 4 o MEDICAL AND SURGICAL EMERGENCIES. 

themselves ; they were unsuccessful ; defeat after defeat followed 
them ; anxiety, worry and loss of sleep and continued disappoint- 
ments wore upon their minds ; the heart sympathizes through the 
nervous system. I recall one particularly sad case, in which pain 
at intervals over the region of the heart was very acute and resisted 
all remedies for upwards of a year, when the man died, so far as 
we could observe, from a "broken heart." Many illustrations could 
be given of a similar kind, of reverses and disappointments, when 
the heart sympathized, and in many cases the mental depression 
was so great that attempts at suicide had been made, and many 
accomplished the dreadful act. 

Symptoms of heart failure. When there is no acute disease to 
cause failure of the heart the first symptom is an unusual restless- 
ness, coupled with an extreme sensibility and irritability. Success 
and failure act upon him as one and the same thing, and follow 
loss of sleep ; his business by day follows him through the night, 
and he may be haunted by dreams. Whenever a man or woman 
who is actively engaged, dreams regularly of his work, whatever 
it may be, he or she may receive this as a warning that he is doing 
too much work, and that the excitement and mental strain of the 
day is being carried into the night. If this condition continues, 
the night is passed in feverish restlessness, with a desire for pro- 
longed sleep in the morning, which cannot often be granted, then 
follows a stage in which dark physical and mental periods succeed, 
which proclaims the mischief which has been brewing for some 
time. Along with this sleepless condition his inability to digest a 
proper amount of food ; and meals, which have been probably taken 
at irregular intervals, and in haste, become objectionable ; appetite 
is capricious, and when food is taken a fulness of the stomach su- 
pervenes, and pain, uneasiness and a bloated, distended condition 
of the stomach and bowels. The person becomes known as a dys- 
peptic ; the heart sympathizes and the beats become irregular, and 
great anxiety is felt on this account. In some cases the regular 
circulation is attended with severe spasms of the chest, which is 
known as neuralgia of the heart or "angina pectoris." This pain- 
ful experience will come on with slight provocation from worry, 
fatigue, excitement of passion, and many other depressing emo- 
tions. 

The above symptoms, whenever they occur, should not be 



MEDICAL AND SURGICAL EMERGENCIES. 141 

treated in a trifling manner ; if allowed to go unheeded they will, 
sooner or later, be followed by a serious condition, which the 
most active treatment will not avail. I knew a case of a man 
in one of our asylums who had consulted me a few years before ; 
at my first interview with him he told me had borne a great 
amount of grief, and had been obliged to work as steadily and as 
constantly as a dray-horse ; at that time every organ seemed to be 
in running order, except his heart; the latter was unsteady in its 
action and so feeble that it was a wonder to me how he lived. He 
had little pain, but was moody, fretful and uncertain; one day, 
some few days after this interview he tried to commit suicide, was 
stopped in the act and placed under restraint ; he has remained so 
for years, a suicidal maniac, ready at any moment, should the 
opportunity present, to rid himself of an existence which has be- 
come a burden to him. 

These cases could be multiplied largely ; another case will illus- 
trate a certain condition which exists in our modern civilization, 
and to a great extent in this country : A man, forty-five years of 
age, who, by unremitting attention night and day, had amassed a 
large fortune. He retired from business ; he had been feeling ill 
before retiring and gave this as a reason for giving up his work. 
Why should he work when he had gained all and more than he 
wanted, and with no one to care for but himself? So he sold 
everything, bought a beautiful place out of town, and began the 
life of a gentleman of leisure ; in a few weeks he became dissatis- 
fied, and this ideal way of living, which he had fostered was a 
delusion. He became ill, fretful, feverish, and depressed ; soon 
existence became a burden ; he consulted me ; he was a man of as 
good physique as any one could wish to see, but with a worthless 
heart. I heard his story and I well knew what was in his mind, 
and notwithstanding his depressed condition his conversation was 
very cautious. I recommended what was best under the circum- 
stances : a cheerful companion and travel ; the advice was ac- 
cepted and acted upon, in part. He made every effort and arrange- 
ment in pursuit of happier life; but, one morning, he was very 
much depressed, and, in this condition, he destroyed his own life. 

The exact mode of death from over-work is by the destruction 
of those parts of the body upon which our life depends, for in- 
stance, the heart, circulation of the blood, and respiration. The 



142 MEDICAL AND SURGICAL EMERGENCIES. 

heart, being the central organ, bears the same relation to the 
human system as the engine does to the machinery in a large fac- 
tory. When the central motive power becomes weakened or 
stopped from any cause whatever, the effect is immediately felt in 
the remotest part of the machinery dependent upon the central 
power for its motion; just so with the action of the heart, by its 
power contained within itself and the nervous system it drives the 
blood to all organs and parts of the body, and keeps up continual 
motion, and by so doing fresh blood is being constantly given to 
the remotest part of the human being, and when, from any cause, 
such as mental or physical strain, over-work, indigestion, intense 
grief or anxiety, from any cause, the heart sympathizes and weak- 
ens or becomes irregular, so with everything dependent upon it, 
and consequently the whole system becomes disorganized. 

SOME DETAILS OF INJURIES TO THE HEART AND BLOOD-VESSELS. 

The disease called "aneurism," is a wearing out of some of the 
large blood-vessels, generally near the heart. These vessels become 
enlarged in one place and weakened, and form a little sac or bag 
at this point of weakness and, as a result, the blood is retarded and 
this pocket or sac becomes filled, and after a time, it may rupture 
from pressure or excitement, or the irregular action of the heart 
may cause immediate death. This condition was formerly noticed 
to occur frequently among those who rode carriage horses in 
England. It is said to occur most frequently in those who have 
to perform daily very active exercise, such as artillery-men, post- 
men, post-boys. 

There is another form of disease of the heart which is due to 
wearing out or wasting of that organ, also from continued exertion ; 
the exertion may not be violent but it may be continued for a long 
time, is found among post-men, laborers who perform an ordinary 
day's work and walk long distances to and fro, and among travel- 
ers who walk long distances on foot, blacksmiths and among sports- 
men who take active exercise. It must be remembered that the 
ventricles or walls of the heart have an enormous amount of work 
to do, when we take into consideration that one ventricle, the left, 
has to make one hundred thousand strokes in twenty-four hours, 
and thereby drive over to the lungs eighteen thousand, seven hun- 



MEDICAL AND SURGICAL EMERGENCIES. 143 

dred and fifty pounds of blood. It must also be remembered that, 
during sleep, while every other organ may be inactive the heart 
must still continue to do service. 

INFLUENCE 0? PASSION ON THE HEART — EFFECTS OF ANGER. 

We say a person may become "red with rage," or we may say he 
was " white with rage," and by these two terms we express the 
degrees of comparison and the extent of fury. "Red with rage" 
means partial paralysis of the small blood-vessels over the surface 
of the body. "White with rage" means temporary suspension of 
the circulation. The effect of rage upon the heart is to tempora- 
rily prevent its action and the first effect will be noticed in the 
irregular action. 

I once knew a medical gentleman who allowed his temper to 
become so violent, that at times his friends became alarmed for 
himself and others ; and when the attack was over he experienced 
very sad hours of sorrow and regret. In the midst of one of these 
outbreaks of anger he suddenly felt, to use his own words, "as if 
my heart were lost ;'' he reeled under the shock, was nauseated and 
faint, and, after recovering, he put his hand to his wrist and dis- 
covered an irregular, intermittent pulse, this was undoubtedly the 
cause of his faintness. He lived for ten years after but never 
entirely recovered from that shock and his heart was never free 
from disease. 

EFFECTS OF HATRED. 

Hatred, when intense, acts much like anger in the effect it pro- 
duces. Hatred differs in that it comes on suddenly and is more 
closely concealed. 

EFFECTS OF FEAR. 

The effects of fear are almost identical with those of rage, and, 
like the latter grow in force with repetition. The phenomena are 
so easily developed in the majority of persons that they can be 
actually acquired by emotion and are often intensified by the mere 
narration of events. Illustrations of the effects of fear have come 
under the observation of almost every one who has had to do with 
children. Once thoroughly frightened in infancy it is with the 



144 MEDICAL AND SURGICAL EMERGENCIES. 

greatest care and caution that the phenomena do not follow even 
after adolescence. As an illustration of the effects of fear, the 
following was experienced by a gentleman while returning home 
from a long sea-voyage, in perfect health and spirits : The vessel 
in which he was sailing was struck in a collision, was hopelessly 
injured and began to sink. With the sensation of the sinking of 
the ship and the obvious danger of death, this gentleman felt his 
heart stop its beat ; he lost consciousness, and the first knowledge 
he had was when he discovered himself being conveyed out of the 
sinking ship to the deck of another. When he had recovered 
partially from the fright he found that the action of his heart was 
intermittent. On reaching land the intermittency decreased, and 
after a long course of treatment, the heart gradually returned to 
its normal condition. 

EFFECTS OF GRIEF. 

The effects of grief vary often according to the suddenness or 
slowness with which it is experienced, also as to the constitution 
and condition, mental and physical, of the person who receives the 
intelligence. Sudden grief has a powerful influence upon the 
action of the heart, leading to irregular action and affecting the 
whole circulation and extending to the nervous system. Many 
cases are recorded of mental depression which subsequently de- 
veloped into hopeless cases of insanity as the result of the effects 
of sudden grief. 

TREATMENT OF DISEASES OF THE HEART. 

In no disease of the human body is the old adage more strictly 
true, namely, "an ounce of prevention is worth a pound of cure," 
than in diseases of the heart. In all cases of heart disease, from 
whatever cause, rest is of the utmost importance, and must be in- 
sisted upon at all hazards, and must be mental as well as physical. 
The appetite, emotions and passions must be under perfect control. 
Straining, especially when the hands are above the head, is to be 
avoided. It is absolutely necessary that the individual suffering 
from heart disease should understand his exact condition and be 
governed accordingly, as, for the most part, the treatment is in his 
own hands. After rest comes next in importance diet ; the nutrition 



MEDICAL AND SURGICAL EMERGENCIES. 145 

of the body must be sustained, sweets, vegetables and animal fats 
must be used sparingly ; the diet should consist of food which con- 
tains the largest elements of nutrition, such as graham and brown 
bread, eggs, milk, beefsteak, oysters and a moderate amount of 
stimulants in cases in which there is difficult breathing; in very 
many cases the latter condition, or want of breath, is due to the 
weakened condition of the action of the heart ; in this class of cases 
egg-nog will be of value, given at regular intervals. In no case 
should the stomach be overloaded. If the latter organ is filled with 
a due amount of black, indigestible food, it is sure to oppress the 
patient and interfere with the action of the heart, consequently 
the necessity for a small amount of food in some concentrated 
form, and taken at regular intervals. The medical treatment of 
heart diseases is unsatisfactory, there is no medicine known to the 
medical profession which is ; strictly speaking, of curative effect; 
we have in the tincture of digitalis, in five drop doses, given four 
times a day, as powerful a tonic to the action of the heart as is 
found in all medicines ; but rest, proper diet and proper control of 
all the passions, moderate exercise and an abundance of fresh air 
will do more for the relief and comfort of the person suffering 
from heart disease than any or all of medicines combined. 

ANGINA PECTORIS, OR NEURALGIA OP THE HEART. 

Definition. Paroxysms in which there occur sharp, cardiac 
pains, extending usually into the left shoulder and down the left 
arm, accompanied by a feeling of contraction of the thorax and a 
strong sense of impending death. 

Causes. Depending upon variety ; whether of nervous origin or 
organic. Often hereditary; associated with chronic cardiac 
changes, as diseases of the coronary arteries or hardening of the 
valves ; the excessive use of tobacco ; according to Trousseau, it 
is a form of masked epilepsy, and made alternate with true epilep- 
tic attacks ; often associated with hysteria. 

Symptoms. A paroxysmal affection, the attacks occurring 
irregularly ; in the interval, an entire absence of symptoms. 

The patient suddenly sits up in his bed and with a cry of horror 
indicates the sense of pain at the pr?ecordium. This pain is of 
great intensity, but is of a cold and sickening character ; the chest 

10 



146 MEDICAL AND SURGICAL EMERGENCIES. 

is fixed ; the breathing quickened ; and the hand placed over the 
epigastrium, shows that the heart's action is slight and enfeebled. 
The face wears a look of horror, pale and slightly leadened ; a cold 
sweat breaks out upon the forehead; worse than the pain is the 
feeling of fearful sickness and depression. The poor patient gasps, 
"I shall die — I shall die," and sometimes his short but concentrated 
sufferings in a few minutes ends in death. 

The unpleasant sensations of these patients during the attack, 
and the nervous disorder associated with it, slowly bring about a 
mental change. They are depressed and gloomy, sometimes 
suicidal, often developing epilepsy. 

The chief points to be numbered with the attacks are always 
paroxysmal, and extremely painful, patient having a sense of cold- 
ness and frequently a cold sweat. The heart's action is not in- 
creased, but the breathing is slow. This condition is one which has 
caused more or less anxiety, and the services of a physician should 
be immediately called ; the pain of the heart is nearly always an in- 
dication of some very serious disease, and no time should be lost in 
getting all the information and relief possible from the very best 
authority. 



DIABETES AND BRIGHT'S DISEASE. 

Varieties — Diet and Treatment. 

Diabetes is of two kinds : in one form there is sugar in the urine ; 
and in the other there is a large increase in the amount of urine 
voided, but no sugar is found. Diabetes is a disease of early adult 
life ; is met with more frequently in males than in females ; and in 
some cases is hereditary. It is a progressive disease, although it 
has no regular course. In cases where the regulation of the diet 
reduces the amount of sugar in the urine the fatal termination may 
be delayed. The disease may last from a few weeks to ten or 
twelve years. 

diet and treatment. 

The diet is of the first importance ; forms of food which contain 
starch and sugar should not be taken, hence bread, arrow-root, 
tapioca, sago and such vegetables as potatoes, parsnips, turnips, 
carrots, beans and peas are to be absolutely avoided. Salads, 
greens, acid fruits, all kinds of flesh and fowl, eggs, cheese, and 
butter, unsweetened tea and coffe can be taken. Liquors in any 
form are harmful ; if a stimulant is absolutely needed, a little light 
sherry or claret wine may be permitted. To allay the intense thirst 
sour drinks, cracked ice and some alkaline mineral waters may be 
used in moderate quantities. A meat diet is desirable. A variety 
is always a necessity. Gluten breads, bran cakes, and biscuits and 
buns made from almond flour have been devised as substitutes. 
Some patients cannot eat bread thus made, and in such cases, if 
bread must be taken, it should be well toasted. Moderate exercise 
must always be advised, and the skin should be kept thoroughly 
active by means of warm baths. 

Medical remedies are of use, but are of secondary consideration. 
The remedy probably most used in these cases is opium in some 
form. In all cases proper regulation of the diet is of the first im- 

147 



148 MEDICAL AND SURGICAL EMERGENCIES. 

portance, and the suffering patient will soon learn what agrees 
with him and so adjust his diet that he will receive the greatest 
benefit possible. 




3 



Fig. 19. Cross section of the right kidney. 

Codeine, grs. eight. 

Syrup, oz. one. 

Water, oz. one. 

Take half teaspoonful every four hours. 

See other prescriptions for this disease under this head. 



MEDICAL AND SURGICAL EMERGENCIES. 149 



BRIGHT S DISEASE. 



There are several diseases which have been called after Dr. 
Bright, who first called the attention of the profession to this dis- 
ease in the year 1827, which he showed was of common occurrence, 




Fig. 20. The right kidney, about natural size. No. 1, renal vein; 
2, renal arteries; 3, ureter. 

and which was frequently associated with general dropsy. The 
disease consists of an inflammation of the kidneys, which may be 
either acute or chronic. It comes on frequently after a sudden 
exposure to cold. 

Among the first symptoms is a slight pufnness about the eyes, 



150 MEDICAL AND SURGICAL EMERGENCIES. 

in the morning; if the patient is anemic, the puffiness may appear 
in the feet and ankles at the same time. It generally increases 
very rapidly. Towards evening there is a little quickening of the 
pulse and a slight rise of temperature, together with headache. 
There may be some pain in the back and loins, also nausea and 
vomiting. These, in brief, are some of the symptoms which usher 
in a mild form of Bright's disease. 

The urine in all varieties is diminished in quantity, high colored, 
and sometimes smoky in appearance ; it is of high specific gravity ; 
a sediment forms in the urine soon after being voided; albumen 
is found in the urine. 

Dropsy occurs early in the disease. Nervous symptoms are of 
great importance, and prominent ; these symptoms are due to the 
presence of some irritating poison in the circulation. 

TREATMENT. 

Eor the successful management of acute Bright's disease, what- 
ever may have been the exciting cause, the patient must be kept in 
bed, in a large, well-ventilated apartment, with a temperature of 
75 F. Milk should be the only article of diet. Skimmed milk is 
advocated highly ; besides being nourishing, it is a good diuretic. 
Dry cups should be applied over the kidneys, and the infusion of 
digitalis should be freely administered. If this plan is systematic- 
ally carried out from the very commencement, the urine soon 
becomes copious, the albumen gradually diminishes, and the dropsy 
passes away. As soon as the flow of urine commences, the ad- 
ministration of digitalis must be discontinued, and diluent drinks 
are to be given. If the renal secretions be not re-established in 
twenty-four hours, hot-air baths, hydragogue cathartics or pilo- 
carpine hypodermically in one-eighth or one-tenth grain doses are 
to be used. Eor the relief of convulsions or coma, hypodermics of 
morphine should be given. 

Iodide of sodium, one drachm. 
Phosphate of sodium, three drachms. 
Chloride of sodium, one ounce. 
Water enough to make four ounces. 
Take teaspoonful every three hours. 



ERYSIPELAS. 

Some; of the Causes of Erysipelas — Symptoms — Treatment. 

This is a disease which, in many cases, is first developed about 
wounds, cuts or injuries, but it may appear in the human body 
where no wounds or injuries exist. It is a disease of childhood as 
well as of adult life, and may attack both sexes. It is classed among 
the infectious diseases, that is, as we understand the term infec- 
tious, the poison from the one affected with erysipelas may be 
transferred to another directly. If there is an open wound the 
danger from infection is much increased. This disease presents 
the same character in children over six months of age as in adults. 
It may occur in new-born infants. 

SOME OF THE CAUSES OP ERYSIPELAS. 

General debility, indulgence in strong drink, and living or work- 
ing in bad hygienic surroundings. Some individuals have frequent 
attacks of this disease ; there seems to be some condition of the 
atmosphere which affects some individuals. Erysipelas is found 
more frequently, and is much more dangerous in hospitals. When 
once developed it is highly contagious and spreads rapidly among 
surgical patients, and also among women in child-birth. 

SYMPTOMS. 

These may be both constitutional and local, that is, there may be 
a fever and increase of pulse together with a reddened condition of 
the skin, accompanied by severe headache. The temperature runs 
high and may be two or three degrees lower in the morning and 
be attended with sweating. The tongue will be coated ; loss of 
appetite ; nausea and disturbed bowels. The duration of the fever 
is varied. 

When the inflammation of the surface of the body is localized, 

151 



152 MEDICAL AND SURGICAL EMERGENCIES. 

restricted to some part, recovery generally occurs from the fifth to 
the tenth day ; but when it spreads around to different parts, when 
the conditions are favorable for recovery, the latter does not take 
place until three weeks. 

When erysipelas starts from an injury there will be noticed a 
diffuse rose or bright red blush around the point of injury, and by 
pressing the finger and drawing it along the reddened surface a 
white line will follow the finger. Erysipelas of the face commonly 
starts from the nose, eyelid or ear and there is more or less redness 
and swelling which is hot and painful and may involve the whole 
head and neck to such an extent as to greatly disfigure the patient. 
There is danger of erysipelas spreading to the brain and causing 
meningitis. When erysipelas attacks the face and head it is 
dangerous to old people. 

TREATMENT. 

The first thing to be done in all cases is the prevention of the 
extension of this disease, and this can only be done by complete 
separation of the healthy from the sick. A great many remedies 
have been used, none of which seem to be specific. There is prob- 
ably no remedy which has had such extensive use as the old- 
fashioned tincture of iron, and for children the following pre- 
scription : 

Tincture chloride of iron, \ ounce. 
Acetic acid diluted, \ drachm. 
Liquor ammonia acetic, I drachm. 
Simple syrup, \ ounce. 
Water enough to make 3 ounces. 

Dose, one-half teaspoonful every three hours for children from 
five to ten years of age. For a child from one to two years of age, 
instead of the iron a preparation of cinchona may be prescribed ; 
tincture of cinchona, five drops in simple syrup every four hours. 
For external application to prevent the extension of the inflamma- 
tion, there is probably no better remedy than the tincture of iodine, 
which should be applied from the margin of the inflamed skin 
to a distance of about two inches over the sound surface. This is 
not always successful in preventing its spread, but it produces 



MEDICAL AND SURGICAL EMERGENCIES. 153 

no unfavorable results. There is often need of soothing applica- 
tions to the inflamed surface; for this purpose a solution of the 
sugar of lead is employed. Sugar of lead, 4 drachms ; water, one- 
half pint; apply with a soft cloth or sponge every two hours. 
Where there is no abrasion of the surface there is nothing better 
than the following: simple vaseline; or the following: 

Glycerine, 1 ounce. 
Carbolic acid, 20 drops. 
Water, 2 ounces. 

This can also be applied every two hours with a soft cloth or 
sponge. 

The strength of the patient must be kept up, and for this pur- 
pose beef-tea should be properly prepared and given at intervals 
of two hours. Milk, in the form of egg-nog, should also be given 
three times a day. These should be alternated as indications seem 
to require. 



LA GRIPPE OR INFLUENZA. 

Cause; of La Grippe — Symptoms — Treatment. 

This disease is known by both of those names. It is an epidemic 
accompanied by catarrhal fever; it affects the membranes of the 
nose, throat and throughout the respiratory tract, also the organs 
of digestion, and, in the majority of cases, there are profound 
disturbances of the nervous system. As an epidemic it spreads 
rapidly over entire continents, and attacks the greater part of the 
population, irrespective of age or sex, except infants, who are 
known to be free from the invasion of this disease. 

CAUSE OF I«A GRIPPE. 

It is thought at the present time that the cause of this disease 
originates in some powerful diseased agent in the atmosphere. It 
is now well known to be a germ and is contagious, affecting whole 
families and communities and large sections of countries. 

SYMPTOMS OF LA GRIPPE. 

It is preceded for twenty-four or forty-eight hours by a general 
indisposition, in the majority of cases; in some, however, it comes 
on suddenly, with chilly sensations alternating with flashes of heat 
and attended by severe headache, pain in back and limbs, con- 
striction of chest and muscular weakness. This is usually followed 
by a discharge from the nose and the congested appearance of the 
eye, sore throat, frequent hacking cough, and, in many cases, 
difficulty of breathing. There are also paroxysms of sneezing and 
sensations of stuffiness in the head, and, not unfrequently, this 
congested condition extends to the ears. There is severe headache 
(this is a common symptom), often great soreness of the muscles, 
attended, in many cases, by sharp, neuralgic pains ; in some cases 
great despondency and prostration and even delirium, while mental 

154 



MEDICAL AND SURGICAL EMERGENCIES. 155 

disturbance is present in many cases. In most epidemics of la 
grippe there is great restlessness and sleeplessness ; the fever rises 
rapidly to 101 to 102 Fahr., and sometimes as high as 104 or 
105 . This disease is not very liable to be mistaken for any other, 
except a mild attack of bronchitis. 

TREATMENT OF I^A GRIPPE. 

It has been observed that those who are exposed to the outer air 
suffer most from this affection; it is consequently wise during 
epidemics, for children and those enfeebled by disease and age to 
remain as much as possible indoors. As one of the many symptoms 
of this disease is great nervousness it is good treatment to fortify 
the nervous system against an attack by tonic doses of quinine and 
nux vomica in the following composition: sulphate of quinine, 
two grain capsules every four hours and five drops of the tincture 
of nux vomica in a little water, to be taken before eating and once 
at bed-time. 

When the attack is well on the following is one of the best 
remedies, and is used extensively in all epidemics by leading physi- 
cians : 

Sulphate of quinine, grs. xx. 
Phenacetine, grs. xxv. 
Capsule No. 2, xv. 
M. S. One every three hours. 

These, in capsule form for an adult, should be taken every three 
hours for the first twenty-four or thirty-six hours. If there is 
considerable fever present, cooling drinks, such as lemonade, after 
the following formula, are valuable : 

Juice of one lemon. 

White of one egg. 

Sherry wine, three tablespoonfuls. 

Water enough to make one glass. 

This to be drank as patient requires. 

During the first forty-eight hours gentle laxatives should be 
given. There is probably no better than cascara sagrada com- 
pound, from one-half to one drachm, as often as is necessary. 



156 MEDICAL AND SURGICAL EMERGENCIES. 

i 

There is nothing better to relieve the pain in the chest than the 
phenacetine in the above prescription. If there is much pain and 
tightness over the chest, a local application of turpentine should 
be made, as turpentine, six ounces and the white of one egg f 
thoroughly mixed. This can be applied with flannel over the 
tender parts and, if the flannel is left on, it should remain long 
enough to cause irritation or redness of the skin, when it can be 
removed, and, if the pain remains, the same treatment may be used 
again. 

If proper precautions are taken there are generally no serious 
complications remaining, unless the person affected has suffered 
from some organic disease heretofore. 

Some well-known prescriptions for influenza: 

Tincture aconite root, -J- drachm. 

Sweet spirits of nitre, 3 drachms. 

Citrate of potassium, 3 scruples. 

Water enough to make 1 ounce. 

One teaspoonful every four hours during first day of attack. 

For the cough in first stage : 

Tincture benzoin compound, 1 drachm. 

Add to one pint of boiling water and inhale the steam. 

For the bronchitis in the early stage : 

Wine of ipecac, 2 drachms. 
Citrate of potassium, 2 drachms. 
Syrup wild cherry, 2 ounces. 
One teaspoonful every two hours. 

For the bronchitis in the later stages : 

Chloride of ammonia, 40 grains. 

Tincture of cubebs, 1 ounce. 

Syrup wild cherry, enough to make 4 ounces. 

One tablespoonful every three hours. 

For stimulation throughout the attack : 

Sulphate of strychnine, 1-40 grain every two hours. 



AFFECTIONS OF THE LIVER. 

Function al Derangements oe — Symptoms — Treatment — 
Physiology oe Digestion. 

3rief resume oe the aeeections oe the liver, together with 
the physiology oe digestion. 

The liver is the largest gland in the human body, and it is the 
seat of some of the most important affections of animal life. It is 
of a reddish-brown color, measuring about twelve inches in length, 
six inches wide, and three inches in thickness, and weighs from 
three to four pounds. It is located high up in the cavity of the 
abdomen, beneath the lower ribs and the midriff of the right side, 
and opposite the stomach, which it partly overlaps. It is con- 
cerned in the secretion of a thin yellowish fluid, of a bitter taste, 
.and slightly alkaline substance called bile. 

The liver is composed of a great multitude of blood-vessels, 
nerves, absorbents, and bile ducts, all united together by a granular 
substance, and covered with a thin serous membrane. In one re- 
spect the liver is peculiar, and differs from any other organ of the 
body. It receives two kinds of blood, arterial, red blood, from the 
hepatic artery, to nourish its substance, and dark venous blood 
from the portal veins, out of which it secretes the bile. The bile 
•ducts originate in minute branches in the interior of the liver and 
unite together, emptying into the gall bladder under the liver. 

When our food has been reduced by the action of the saliva, the 
teeth, and the gastric juices, to a soft pulpy consistency resembling 
flour paste, it is then discharged from the stomach into the duo- 
denum, and when it reaches the mouth of the gall duct, it stimu- 
lates the gall bladder to action, causing its fibrous coats to contract 
and pour out the bile into the duodenum, where it mixes with the 
food and at once converts its oily, fatty substances into a creamy 
emulsion fitted to be absorbed into the blood. 

157 



158 MEDICAL AND SURGICAL EMERGENCIES. 

It will be observed that the bile is not poured into the stomach, 
as many people imagine, but into the duodenum, some six or 
seven inches below the stomach. If this fact, that the bile did not 
enter the stomach, was generally known by the masses of mankind, 
what a powerful influence it would have on the price of antibilious 
physic or mandrake pills, etc. How many unfortunate people have 
had to take cart-loads of pills and physic to cleanse the bile out of 
the stomach, when it does not go into it. Not much more than 
half of the old routine physicians know whether the bile empties 
into the stomach or the small intestine below the stomach; when 
their patients eat and drink too much, they are said to be bilious, 
and they puke and physic them ! No bile ever enters the stomach 
except when the action of the stomach and intestines is reversed, 
as seen in the act of vomiting. 




Fig. 21. Nos. 1 and 2, liver; S, gall bladder. 

FUNCTIONAL DERANGEMENTS OF THE LIVER. 

The liver, like all other organs in the body, is liable to disease. 
The action of the liver becomes sluggish very frequently, espe- 
cially among those who lead an inactive life, or whose business 
necessitates their being indoors. 

SYMPTOMS. 

The prominent symptoms which usually attract the patient's 
attention are loss of appetite, and a bitter taste in the mouth ; the 
tongue is large, pale and flabby, with indentations of the teeth 
along its edges. The patients who suffer from this form of liver 



■ 



MEDICAL AND SURGICAL EMERGENCIES. 159 

trouble may become very fat, or they may become the opposite. 
They complain of drowsiness, inactivity, pain in the limbs often 
shooting up from the right side of the shoulder. Headache, usual- 
ly in front, is very common, especially when indiscretions in eating 
have taken place. Dizziness, dimmed eyesight, and a feeling of 
mental depression, and irritability of temper may occur in conse- 
quence of deranged liver affection. 

TREATMENT. 

The best treatment is a regulation of the diet and outdoor exer- 
cise. All foods containing starch, and sweet substances should 
be avoided, or taken in small amounts. Wines and liquors should 
be wholly discarded. Fresh air, sea air especially, and moderate 
exercise, together with the avoidance of extreme mental work 
should be recommended. Prescriptions to assist in the relief of 
this trouble will be found in the latter part of the book under the 
head of formula. 

PHYSIOLOGY OF DIGESTION. 

As already shown, the process of digestion is very complicated. 
It commences in the mouth, where the food is masticated by the 
teeth, and this is thoroughly mixed with the saliva, and reduced 
to a soft pulpy mass and fitted to be swallowed into the stomach. 
The saliva acts as a kind of ferment, converting the starch into 
sugar, and then changing it to a lactic acid, to aid digestion, after 
the food is swallowed into the stomach. 

When the food reaches the stomach, it acts as a healthy stimu- 
lus, increasing the flow of blood into the blood-vessels of the 
stomach, causing the gastric juices to be secreted in large quanti- 
ties, which, when brought in contact with the food, attacks its 
albuminous materials, such as lean meat, eggs, milk, cheese, the 
gluten of bread, vegetables, etc., and soon reduces them to a fine, 
pulpy mass, of a gray color, and slightly sour to the sense of 
taste. The oil, starch, and fat, now being set free by digestion 
of the delicate membranes of the little cells which contain 
them, and not being acted upon by the gastric juices, the starch 
and fat globules are mixed with the digested food, and sent for- 
ward through the pyloric valve into the duodenum. When the 



i6o MEDICAL AND SURGICAL EMERGENCIES. 

food reaches the cavity of the duodenum, it produces a healthy 
stimulus of the liver and the pancreas, causing these organs to 
secrete and pour out into the cavity of the duodenum large quanti- 
ties of bile and pancreatic juice ; these fluids being strongly alka- 
line, at once attract the oils and fat, and quickly convert them into 
a saponaceous emulsion, while the pancreatin of the pancreatic 
juice digests the remaining portions of starch, converting them 
into sugar, so that they may be easily absorbed into the blood. It 




*\g. 22. Inside view of stomach, also gall bladder and section of intestine. 



is well known that starch and oils cannot be absorbed into the 
blood until digested by the action of the bile and pancreatic juice. 
It will be noticed that the liver is a large and powerful organ, and 
only second to the stomach in aiding to digest our food. 

Starch, oils, and fat, are the last and most difficult to digest of 
all kinds of food. It is only when brought into contact with these 
strongly alkaline fluids that they are finally digested, the starch 
being converted into sugar by the action of the pancreatic juices. 
Sugar itself, does not require digestion, being capable of ab- 
sorption without any change into the blood, where it may be found 
in large quantities. 



DISEASES OF WOMEN. 

leucorrhoea — ovarian tumors — irregular menstruation — 
Dysmenorrhea — Menorrhagia — Uterine Hemorrhages — 
Cessation oe Menstruation or Change oe Life. 

eeucorrhoea. 

This condition, vulgarly known as the "whites," is very com- 
mon among women and is the cause of much weakness and ex- 
haustion. It drains the albumen from the blood, causing prema- 
ture decay and old age. The condition consists in a hyper-secre- 
tion from those glands which pour out their contents into the 
vagina or the cervical canal of the uterus, or into the cavity of this 
organ. 

The character of the discharge varies in different cases. In 
some instances it is thick and tenacious, in others so liquid as to 
trickle down the limbs and greatly soil the clothing. 

It is always increased or made worse by exposure to heat and 
cold, over exercise while standing, walking, etc. 

TREATMENT. 

A moderate amount of exercise should be taken, preferably in 
the open air, and late hours and rich foods should be avoided. The 
diet should be light and nutritious. As a general rule anemia is 
present, in which case either of the following prescriptions will be 
of benefit : 

Arsenious acid, J grain. 
Reduced iron, 5 grains. 
Sulphate of quinine, 1 scruple. 

Make into 20 pills. One pill three times a day, after meals, for 
an adult. Or, 

11 161 



162 MEDICAL AND SURGICAL EMERGENCIES. 

Tinct. cinchona compound, 2 fluid ounces. 
Tinct. gentian compound to make 4 fluid ounces. 
Dessertspoonful three times a day after meals. 

The remaining treatment consists in injecting astringent washes 
into the cavity of the vagina. A cheap, astringent injection is made 
by adding 1 ounce of powdered white-oak bark to each pint of 
water, or tannic acid and glycerine in the proportion of 1 ounce 
to 2 quarts of warm water. 

Ringer recommends the following: 

Bicarbonate of soda, 1 drachm. 
Tinct. belladonna, 2fl. drachms. 
Water, 1 pint. 
Use as a vaginal wash. 

Where the discharge is fetid a solution of permanganate of 
potassium should be used as an injection in the strength of \ 
drachm to 1 pint of water. 

These injections should be taken frequently, at least once or 
twice a day, and not less than two quarts of liquid should be used 
at one time. 

A very useful astringent injection may be made as follows: 

Sulphate of zinc, I fluid drachm. 
Sulphate of alum, 1 fluid drachm. 
Glycerine, 6 ounces. 
A tablespoonful to each quart of water. 

OVARIAN TUMORS. 

The ovaries, which are situated on each side of the womb, often 
become enlarged, inflamed and ulcerated, from sympathetic irri- 
tation, caused by disease of the neck and cavity of the womb, 
more especially in women of a strumous or scrofulous constitu- 
tion. When either or both of the ovaries become inflamed, the 
disease is called ovaritis. This disease will cause pain, tenderness 
and soreness inside the edges of the hip bones, in the region of 
the ovaries, much increased on standing and walking. When 
the ovaries become enlarged, they may often be detected, by care- 
ful examination, while lying down and inclining a little to one 



MEDICAL AND SURGICAL EMERGENCIES. 163 

1 
side, by firm pressure of the hand along the region occupied by 

these organs. At first the ovary may be only slightly enlarged, 
soft and tender, but when neglected or improperly treated, it is 
found gradually to increase in size, and becomes hard and shaped 
like a pear, rolling beneath the ends of the fingers as if it was 
unattached to the inside of the body. It may be detected some- 
times more distinctly than at others. Colds, standing and walk- 
ing always appear to increase its size and tenderness. These 
tumors are sometimes firm and solid, but more frequently they 
are encysted, or divided into numerous cells or cysts, like a piece 
of honey comb, and filled with a thin brownish colored fluid, about 
the consistency of honey. These tumors of the ovaries are not 
cancerous or malignant in their character, and are only injurious 
to health and destructive to life in consequence of their great size 
and weight, interfering with the functions of the organs of the 
cavity of the abdomen, chest and pelvis. They will often weigh 
from twenty to forty pounds and sometimes are found to weigh 
much more than that. 

These tumors nearly always originate in some disease of the 
neck or cavity of the womb. 

TREATMENT. 

It is only at the commencement of this disease that there is any 
hope of removing ovarian tumors by medical treatment. When 
the ovaries become irritable, congested or inflamed, with soreness 
or tenderness on pressure in the regions of these organs, the diet 
should be light, digestible and nutritious, and the bowels should be 
kept freely opened, by the use of saline cathartics, such as Rochelle 
salts, or the citrate of magnesia, taken early in the morning, fol- 
lowed by some good alterative tonic, such as the syrup of iodide 
of iron, after eating, three times a day. 

When the womb becomes inflamed, and its functions are inter- 
rupted, the breasts often become irritable, and tender and small, 
hard scrofulous tumors are formed in them, which can only be 
removed by removing the disease of the womb which indirectly 
produced them. The same is true of inflammation of the ovaries. 
Use a warm, salt, hip bath night and morning, and while in the 
bath inject some of it freely, with a good vaginal syringe. Rub a 



164 MEDICAL AND SURGICAL EMERGENCIES. 

little tincture of belladonna into the skin over the inflamed ovaries 
night and morning. 

When there is any leucorrhceal discharge from the vagina, use 
washes recommended for leucorrhcea. 




^Pig. 23. The womb and its appendages. No. 1, vagina; 2, ligament; 3 and 6, the 
ovaries; 4, tbe womb; 5, the opening to the womb. 

IRREGULAR MENSTRUATION. 

The manifestation of the functions of menstruation in the human 
female is simply an indication that she has arrived at the period 
of maturity and that the ova have been formed for the continua- 
tion of the human species. The time when this period arrives 
varies in different countries and climates, and it also depends upon 
temperament, occupation and employment. In tropical countries 
and warm climates, the female often matures at seven, and in 
northern countries and cold climates not before seventeen or eight- 
een. Females of a sanguine temperament mature earlier than 
those who are lymphatic. 

When the constitution becomes impaired and the blood-making 
powers are feeble, or the system has been drained and exhausted 
by disease, or confinement at unhealthy employments, and the 
blood becomes thin and impoverished, menstruation becomes ir- 
regular or ceases. 



MEDICAL AND SURGICAL EMERGENCIES. 165 

When the female ceases to menstruate after this function has 
been established, between the ages of fifteen and forty-five, the 
disease is called suppressed menstruation, which, if not caused by 
pregnancy, is to be regarded as the evidence of failing health and 
to need attention. Cessation of menstruation is often the fore- 
runner of consumption or premature decay. 

TREATMENT. 

In this disease the attention should be directed to the blood- 
making powers and the restoration of the powers of nutrition. If 
the tongue is coated, mouth tastes bad and breath is offensive, an 
irritable stomach and torpid liver are indicated. This condition 
must first be remedied and then a good tonic taken with plenty of 
outdoor exercise. 

DYSMENORRHOEA. 

Dysmenorrhea, or painful menstruation, may be produced by 
different causes. It may depend upon inflammation or disease of 
the womb, or upon contraction of the mouth and neck of the womb. 

When dysmenorrhcea results from the taking of a cold, and is 
accompanied by uterine congestion and irritability, the following 
measures are particularly valuable and may do good in cases de- 
pending upon other causes: 

The patient should take a hot sitz-bath, being well covered 
while in the tub and then get immediately into bed and be covered 
by a blanket. A turpentine stupe may then be used, made as fol- 
lows : A tin containing the turpentine should be placed in a vessel 
of hot water, that the turpentine may be heated without coming 
into contact with a flame. Dip a piece of flannel into very hot 
water and wring it out in a twisted towel, as dry as possible ; then 
dip it into the turpentine and wring again. The cloth should be 
applied while hot and allowed to remain until it causes discomfort, 
but not long enough to blister the skin. From five to ten grains of 
Dover's powder may be administered. 

If the attack is accompanied by constipation a dose of Epsom 
salts is of service. 

In neuralgic dysmenorrhcea, which is dependent rather upon 
nervous disorder accompanying menstruation than upon menstru- 
ation itself, measures should be taken to improve the nervous sys- 



i66 MEDICAL AND SURGICAL EMERGENCIES. 

tern and the nutrition of the patient. These cases generally occur 
in nervous, anemic women, run down by excessive gayety it may 
be, or by the bearing and care of a large family of children. A 
course of strychnine, or quinine and iron in small doses is often 
beneficial in these cases, with moderate exercise and out-of-door 
life between the menstrual periods. 

When painful menstruation depends upon contraction of the 
mouth of the womb, it can only be permanently cured by the forci- 
ble dilation of its contracted orifice, which must be done by a 
physician. 

(See Prescriptions.) 

MENORRHAGIA. 

Menorrhagia is an excessive flow of menstrual blood, either ex- 
cessive in quantity during two or three days, or prolonging itself 
over an unusual number of days. 

When the flow is sufficient to cause decrease of health or to 
indicate disease, it is necessary for the physician to determine the 
form of uterine disease which is responsible for the trouble. 

Uterine hemorrhages may also be produced by fibrous or poly- 
poid tumors, which must be removed to obtain permanent relief. 

Where menstruation is irregular and the hemorrhage is ex- 
cessive, bromide of potassium in the dose of ten grains once or 
twice a day is often very serviceable, and the distilled extract of 
hamamelis in the dose of one drachm, three times a day, is also 
useful. 

When uterine hemorrhages are very profuse and threaten 
death, while awaiting the doctor's arrival, a small sponge may be 
wet in vinegar and water and carefully introduced into the vaginal 
canal. Or in case of an emergency when a sponge is not attain- 
able, a soft linen pocket handkerchief or napkin may be folded, 
wet in vinegar and water and placed in the cavity of the vagina, 
where it serves as a tampon or plug and arrests the hemorrhage. 

CESSATION OF MENSTRUATION OR CHANGE OE LIEE. 

Menstruation usually commences at the average age of fifteen, 
in this country and climate, and continues to the average of forty- 
five, when it begins to decline, becomes irregular and finally dis- 



MEDICAL AND SURGICAL EMERGENCIES. 167 

appears permanently. The womb has now attained the object of 
its creation and at once begins to decrease in size, and in old age 
it is no larger than that of an infant. 

At this critical age many diseases peculiar to women cure 
themselves. When the womb becomes atrophied from old age, it 
is no longer prolapsed, as it is often earlier in life. This period 
of the life of woman is called critical, because while old diseases 
may disappear, new ones are liable to appear. 

Previous to the age of forty-five or thereabouts, her system has 
been drained by the loss of from four to six ounces of menstrual 
fluid every twenty-eight days, which has served to reduce the 
force of her circulation and impair her strength. At this period 
this drainage ceases, and from this time forward all of her blood 
is retained in her system and rapidly increases in quantity and im- 
proves in quality. In consequence, there is a tendency to increase 
in flesh at this period, if the woman is in good health. The waist 
enlarges and the weight of the body rapidly increases. 

The dangers of this period depend upon the rapid increase and 
accumulation of blood, and should be averted by great care in re- 
gard to the diet and other habits of life. The diet should be light, 
simple and easily digested, consisting of cooked fruit and vege- 
tables, with bread and meat once a day. Carefully avoid all stimu- 
lants, and highly seasoned food, wine, beer, coffee, etc. 

As a means of preventing and relieving dangerous engorgements 
of the liver, lungs, heart and brain, and the tendency to conges- 
tion of the lungs and brain, causing fits, convulsions, apoplexy, 
etc., keep the bowels freely open by the use of cooked fruits, whole 
wheat bread, and if necessary a gentle cathartic. 

It is also desirable at this critical period of life to avoid all ex- 
citement of the passions and feelings. 

Fits, convulsions, apoplexy, palsy, etc., may be induced by 
strong mental excitement. At no period during the life of any 
woman is forbearance, sympathy and kindness so essential as it is 
at this turning point in her existence. If she passes happily 
through this crisis, she may look forward with confidence to a 
happy old age, freed from many of the liabilities and diseases inci- 
dent to her earlier life. 



DRUNKENNESS. 

The Scientific Side of Drunkenness, the Keeley and With- 
ered Cure — Diet — Dr. J. D. Crothers of America and Dr. 
Norman Kerr of England on Treatment — Prescriptions 
for Same and How to Use Them — Duration of Life of 
Drunkard. 

There is an impression abroad that quite a large percentage of 
drunkards are born as such, but close investigation has shown 
that the drunkard is made in the majority of cases. He learns to 
drink as he learns to walk, by voluntary action. Some learn 
quicker than others, the same as learning to do any voluntary acts. 
Few men or women become drunkards in less than two or three 
years of practice. Exceptional cases learn the habit in one year. 
Drunkenness becomes a disease, and as such, it should be studied. 
Drunkenness is the changing of a mental state caused by drinking 
too much alcoholic liquor. That alcohol will change one's mental 
state, in fact his whole mental condition, is well known to every 
drunkard. In many cases they take to drink to drown their sor- 
row or smother their troubles. They know by experience that 
liquor will cause them to cease thinking of their sorrow and 
troubles, and to think of something else, and so long as they think 
about the latter, they cannot think about the former. The drunk- 
ard is practically cured of drunkenness when he stops drinking, 
but he is not cured of alcoholism. Every drunkard can be cured 
who wants to be, that is, who has a longing, persistent desire to be 
cured, but it is utterly impossible to cure one who has not such a 
desire. Consequently, the first essential factor in the cure of any 
habitual drunkard is to have his or her consent ; he must be honest 
in this particular. Such a one is what may be termed a normal 
drunkard, because his condition is curable. If the drunkard is 
not a normal one, then he must become so before his treatment will 

168 



MEDICAL AND SURGICAL EMERGENCIES. 169 

be successful. If you succeed in stopping him from drink 
against his will, a relapse will surely follow in a very short time. 

TREATMENT. 

There is no profound secret about a Keeley, or any other cure for 
drunkenness. For convenience, it is divided into five parts. (1) 
The hypodermic injection or "shot;" (2) the tonic; (3) the diet; 
(4) whisky; (5) the "knock-out-shot." 

Regarding (1) the hypodermic or "shot," two injection solu- 
tions are used, which for convenience we will call ( I ) A and ( 1 ) 
B, the formulas being as follows : 

(1) A. 

Atropine sulphate, J grain. 

Strychnine nitrate, 1 grain. 

Distilled water, 1 ounce. 

Cochineal, sufficient to color a rose pink. 

Dose, 2 to 20 minims, three times a day. 

The average hypodermic injection being 10 drops. 

(1) B. 

Strychnine nitrate, I grain. 

Distilled water, 1 ounce. 

Dose, 5 to 15 minims, three times a day. 

The tonic (2), which we will call C, is as follows: 

Fluid extract golden seal (standardized), 2 drachms. 

Ammonium chloride, 30 grains. 

Distilled water, q. s. to 2 ounces. 

Dose, a teaspoonful every two hours while awake. 

The diet (3). For the first six days of treatment the diet should 
consist mostly of Horlick's malted milk. The patient should take 
two teaspoonfuls of it in half a glass of water, "well salted," 
every two hours while awake. He should take it as a medicine. 
He may eat anything else, but insist on the malted milk being 
taken on time. 



170 MEDICAL AND SURGICAL EMERGENCIES. 

The whisky (4). The following should be faithfully carried 
out: 

(a) The patient should furnish his own whisky, and carry it 
with him in a half-pint bottle. 

(b) He should drink only as much as is necessary to keep him 
fairly well braced up — not enough to make him drunk. 

(c) He should go to no place where liquor is kept on sale, and 
should drink no alcoholic liquor except from the bottle he carries 
with him. 

"The knock-out.'' This consists of a hypodermic tablet of 
apomorphine, gr. 1-10, dissolved in 20 minims of (1) water. Of 
this solution inject hypodermically fifteen minims. The object 
of the "knock-out" is to make the patient sick, when he will 
of his own volition stop drinking on the fourth day of the treat- 
ment. 

A few brief suggestions will now be made on the practice and 
principles of the treatment : 

Any physician can treat drunkenness just as successfully as the 
writer or Keeley, provided he understands the principles involved, 
which are quite simple. 

In the treatment of drunkards the two sides of human nature 
(a) the mental and (b) the physical, must be kept in view. 

Let a person drink one or two ounces of whisky ; in a short time 
he will experience a change in his mental state ; he will feel exhil- 
arated and quite a high degree of exaltation, but his physical 
state will not be apparently changed. Should he take a few more 
drinks he would soon feel quite a marked change in his mental 
state. The first effects of whisky then are mental, later physical. 

In the cure of drunkards the cure is directed to the mental state 
of the patient. We have nothing to do with him physically except 
as certain temporary, physical conditions may influence him men- 
tally and these, of course, we try to counteract. 

It may seem strange, but nevertheless it is a fact, that when all 
of the different successful methods for the cure of drunkenness, 
as the Witherel, Keeley, the purge method, the bromide method, 
the various treatments in sanitariums, etc., are all analyzed scien- 
tifically and boiled down, the residuum is the same — it is all mental. 
And this is also true when the drunkard is cured by means of the 
pledge, or by prayer, or by religion, or when he cures himself. 



MEDICAL AND SURGICAL EMERGENCIES. 171 

« 

Any drunkard, periodic or continuous, who earnestly and hon- 
estly desires treatment, is three-fourths cured before he gets his 
first injection. 

The success of the remaining fourth is entirely dependent upon 
how thoroughly you can impress the patient or make him believe 
the medicines you use will surely cure him. They are simply the 
means you use to plant the suggestion of cure. A suggestion can 
be planted consciously only directly; that is, through some medi- 
cine; and the injecting solutions are the medium. 

Regarding his treatment the patient is in a complex mental 
state, composed of three principal elements: (a) He is anxious 
to be cured, (b) He believes that the medicines will cure him. 
(c) He expects to be cured. As physician, you keep these three 
states active, but play principally on the medicines, and make them 
the medium by which you change the current of thought, or bring 
about a mental reaction from thinking of whisky to not thinking 
of it. 

Dr. T. D. Crothers, of America, and Dr. Norman Kerr, of Eng- 
land, both eminent specialists in the treatment of alcoholism, hav- 
ing both spent a lifetime in the work, speak highly of the Turkish 
bath, especially in beginning the treatment. Rochelle salts with 
bitartrate of potassium every two hours, is also highly recom- 
mended. When the patient suffers from indigestion and loss of 
appetite, the following will be found useful : 

Infusion of columbo, 2 ounces. 

Aromatic spirits of ammonia, 3 drachms. 

Co. tinct. of cardamon, 4 drachms. 

Distilled water, 3 ounces. 

A teaspoonful in a wine glass full of water every three hours. 

If there is extreme nervousness and inability to sleep, the follow- 
ing will be found useful : 

Potassium bromide, 3 drachms. 

Hydrate of chloral, 2 drachms. 

Peppermint water, enough to make three ounces. 

Dose — A teaspoonful in a wine glass full of water every four 
hours, or as often as seems necessary, and the condition of the 
patient warrants. 



172 MEDICAL AND SURGICAL EMERGENCIES. 

The prescriptions should all be given, so far as possible, under 
the advice of a physician. Tonic should be given for quite a long 
time after the individual has stopped taking any liquor, or has 
any craving for it. The poison which is in the system must be 
gotten rid of, and while nature is doing this, and after it is done r 
the nervous system needs building up. And for a remedy to take 
for several weeks, or even months, the following has been found 
useful, by Kerr: 

Tinct. nux vomica, 2 drachms. 
Dilute nitric acid, 2 drachms. - 
Solution taraxacum, I ounce. 
Tinct. cardamon, 2 drachms. 
Water enough to make three ounces. 

A teaspoonful dose should be taken four times a day, before 
eating, and before going to bed. 

DURATION OF UFE OF DRUNKARD. 

Investigation has shown that the average duration for men of 
the drinking habit was about fifteen years. Among periodical 
drunkards, the average duration was about nineteen years. In 
general, it may be concluded that hard drinking can rarely be car- 
ried on for more than twenty years, and it generally ends the life 
of the person at the age of about forty years. 



THE USE OF TOBACCO. 

How it Affects the: Blood and Alimentary Canal, and the 
Nervous System — Effects of Smoking and Chewing — 
Some Clinical Examples of the Effects of the Use of 
Tobacco — Cigarette Smoking — Effect on Boys — Nicotine 
the Most Deadly Poison. 

some remarks on the use of tobacco. 

The use of tobacco, when first introduced into the civilized 
countries, met with much opposition. Popes and kings attempted 
to interdict it, and as late as the seventeenth century, it was pro- 
hibited by law in Turkey and Persia, where now its use is almost 
universal. Even at the present time, there is a wide difference 
of view as to the effects of its constant use. Some see no -limits 
to its ill-effects, while others believe that it does very little harm 
whatever. But such extreme views are held by extremists only. 
While the conservative observer recognizes the well-known fact 
that tobacco may be and often is the cause of a disease, and it is 
very commonly recognized as being the source of harm, the habit 
is so universal that we forget or overlook that which is so 
constantly before our eyes. I will briefly mention a few cases re- 
cently in my observation, to emphasize the truth of this statement. 

The first, a man of forty-five years of age, had been suffering 
for a long time from attacks of vertigo, unsteadiness of gait, and 
other nervous symptoms. He had been treated for months by a 
physician of high repute and large experience, who had wavered 
much in his opinion, but finally diagnosed grave, organic trouble. 
The patient had been addicted to excessive smoking. I or- 
dered him to discontinue this altogether, and he was soon in com- 
parative health. 

The second case was a man of fifty years who had suffered peri- 
odically since he was fifteen years of age with various nervous 

173 



174 MEDICAL AND SURGICAL EMERGENCIES. 

symptoms; twitchings of the muscles of the face, want of 
sleep, and digestive disturbances were very prominent. These 
symptoms were persistent, remaining a year at a time. He had 
been a moderate smoker since boyhood. Upon consulting me, I 
prohibited smoking, and the above train of symptoms disap- 
peared immediately. These two cases are but typical of many 
more which could be enumerated, and which are frequently seen 
in the practice of every physician. 

Tobacco, taken internally, is one of the most deadly poisons ; 
nicotine, the active principle in tobacco, will kill very rapidly. 
According to experiments on animals, and observations on man, 
it directly affects the central nervous system, the brain, and the 
spinal cord, as well as the smaller nerves. 

The blood also is affected. It poisons the red and white cor- 
puscles, and destroys the coloring matter of the blood. It also 
affects the alimentary canal, the salivary glands, and the kidneys. 

In studying the injurious effects of tobacco on the nervous sys- 
tem, we have found that smoking chiefly affects the nervous sys- 
tem, while chewing more frequently affects the digestive system. 
The poison in tobacco is not so strong in pipes as it is in cigar- 
ettes or cigars. The chief injury of cigarettes is from the fact 
that they are smoked so much by the young, and perhaps that they 
also lead to excessive smoking. The amount of nicotine in tobacco 
varies from two to eight per cent. Good Havana has two per 
cent, and is therefore the best. Most individuals acquire a toler- 
ance for the use of tobacco, and continue to use it without apparent 
harm. Those of a neurotic temperament are likely to suffer most 
readily. It appears also that those who lead a sedentary life, or 
are much in a smoke-laden atmosphere, or are accustomed to inhale 
the smoke, are more affected than those in the open air who do 
not inhale the smoke into their lungs. Tobacco is especially dele- 
terious to the young. It often seriously impairs the general 
health, as well as causes nervous diseases. 

CIGARETTE SMOKING. 

This form of smoking possesses all the injurious qualities com- 
mon to all other forms of the tobacco habit, with the addition of 
a powerful irritant poison, an empyreumatic oil, also generated by 



MEDICAL AND SURGICAL EMERGENCIES. 175 

the burning of pepper. It seems to be overlooked by most observ- 
ers that tobacco is rich in nitrate of potash, which greatly assists 
the process of combustion in smoking, and is converted to oxide of 
potash, the caustic properties of which are visible in the mouths 
and throats of all smokers — the empyreumatic oil and the nicotine, 
pyridine, and caustic potash, are present in all cigarette smoke; 
and as the tobacco used for cigarettes is somewhat milder than is 
used for cigars, the habitues are constantly inhaling the smoke in 
large volumes, which more than compensates for the lack of the 
high percentage of the nicotine in the tobacco. 

It is the unanimous opinion of teachers that boys who smoke 
cigarettes cannot concentrate their minds, and at once show de- 
ficiencies in their capabilities in learning arithmetic and grammar. 
No boy who smokes cigarettes before the age of ten years will 
ever learn to spell correctly ; failing memory, nervous excitement, 
physical debility and muscular tremor, are to be noted among the 
earlier manifestations of the cigarette habit in boys. 

The late Prof. James T. Whittaker, in his work on the practice 
of medicine, speaking of nicotine, designates it as one of the most 
dangerous poisons, ranking next in virulence to hydrocyanic 
acid. The effects of the cigarette habit upon boys are now at- 
tracting the attention of the philanthropists and scientific men all 
over the world ; so much so, that according to Prof. Willis Brown 
of Toronto, there were in 1900, 2,193,390 less cigarettes made than 
in the previous year. Within the past six months more than 
100,000 people in the United States have pledged themselves to 
oppose the cigarette habit in every manner. Twenty-six states 
have enacted laws against it, and, if the medical profession does 
its duty, the time will soon come when the terrible, degrading and 
disagreeable habit of smoking and chewing tobacco, in any form, 
will be extremely rare among respectable and intelligent people. 

The treatment of all forms of the use of tobacco is entire absti- 
nence. The mere lessening of the amount used ends in entire fail- 
ure. There are few but that can relinquish its use, and an expe- 
rience extending over many years in the treatment of all forms 
of drug and alcoholic habits warrants me in advising the aban- 
doning of its use entirely, where there is any doubt as to its caus- 
ing any serious results. 



INSANITY. 

Seriousness of the Disease — Some Common Symptoms — Dif- 
ficulty and Necessity for Early Diagnosis and Treat- 
ment — Curability of a Large Per Cent, of Cases if Seen 
Early, and Proper Treatment Given — Institutional Ver- 
sus Home Care and Treatment — The Future of Cases or 
Prognosis — Variety of Forms and Symptoms 

recognition and care of those mentally afflicted. 

The care and treatment of our insane is a question which ought 
to interest every physician and taxpayer in the state. We have, in 
round numbers, in the various asylums and institutions where the 
insane are cared for, about five thousand persons, necessitating an 
outlay of about five million dollars and an annual expense of about 
one million five hundred thousand dollars for care and treatment. 
Not only is the question one of interest from an economical stand- 
point, but it is of the utmost interest sociologically. Insanity, in 
some form, permeates all classes of society; no one can claim 
exemption. No disease is so far-reaching in its effects nor in- 
volves a wider range of interest regarding individuals, families, 
and even communities. For the individual, social and business 
relations are at once seriously involved ; for the family, the dear- 
est ties on earth are disturbed ; in many instances there is personal 
danger, and it may be, the removal of the head of the family to 
the care of strangers, with the consequent loss of income and neces- 
sary expense, and, unfortunately, the stigma wrongfully attached 
to persons, and even families, known to be tainted with mental 
disease. However, whether treatment be administered, at home or 
in a public or private institution, there is involved an expenditure 
of a large amount of public or private funds. 

There is, perhaps, no disease which, when it attacks any mem- 

176 



MEDICAL AND SURGICAL EMERGENCIES. . 177 

ber of a family, creates so profound an impression. Take, for in- 
stance, the mother with child, it may be her first or it may be her 
sixth ; the child is born, and the physician and friends are looking 
forward to a speedy and happy recovery, when, like a thunderbolt 
from a clear sky, the friends' joy is turned into intense anxiety, 
the resources of the physician are taxed to the utmost. 

In this hour of sorrow, the family look to the physician for 
counsel and advice. 

SYMPTOMS. 

A week or ten days after parturition, the patient's face becomes 
pale and careworn in appearance ; the eyes unnatural in lustre ; skin 
moist, tongue coated, breath offensive, lochia suppressed, tempera- 
ture high; patient becomes restless, attempts to jump out of bed 
or window ; conversation incoherent. These are a few of the pre- 
monitory symptoms which call for prompt recognition by attend- 
ing physician. I recall two cases which came under my care for 
treatment. One patient was not considered in serious condition 
until, by accident, her husband found that she had secreted a large 
butcher knife under her pillow. When questioned, she acknowl- 
edged her intention of killing both husband and child after they 
had gone to sleep. The other case was that of a woman who con- 
templated roasting her infant in the oven, but vigilance prevented. 

DIFFICULTY AND NECESSITY FOR EARLY DIAGNOSIS. 

We have come to look upon insanity as a disturbance of the 
intellectual areas of the brain, manifested by partial or complete 
derangement of the mental faculties, a derangement manifesting 
itself in methods of thinking, feeling, and acting, which are un- 
usual to the individual when in mental health. There is no com- 
mon standard of sanity, by which mental aberration can be 
judged, because no two individuals act and think alike. No indi- 
vidual can be called insane because he differs mentally from 
others. Every individual has his own standard of mental action, 
and can be considered insane only when he departs from his own 
standard, when normal mental action is supplanted by abnormal 
mental action, or when, in common parlance, he is "off his base." 

Insanity may be considered a relative condition. We must com- 
12 



178 MEDICAL AND SURGICAL EMERGENCIES. 




Fig. 24. View showing the nervous system. 



MEDICAL AND SURGICAL EMERGENCIES. 179 

pare the condition in which we find the individual at the time of 
examination, his conduct, manner, and speech, also the organs of 
the body, including the eyes, tongue, skin, circulation, appetite, 
bowels, sleep, motion and sensation, with his normal mental and 
physical state, as shown by his former habits, temperament, en- 
vironments, etc. A nervous, excitable temperament may from 
slight cause become exalted or depressed, which up to a certain 
degree would be within the normal physiologic range in that indi- 
vidual, while such manifestations occurring in another individual 
of entirely different temperament, might justly stamp him as in- 
sane. Thus two individuals may manifest similar mental symp- 
toms, and one be considered of sound mind, while the other may 
very properly be considered insane. It is when mental activity 
goes beyond the physiologic limits and the individual passes into 
a psychopathic state, that he may be regarded as insane. It is 
often very difficult to say where health ends and disease begins ; 
the onset, if gradual, may extend for months and even years, be- 
fore the lines between sanity and insanity are well defined. 

NECESSITY FOR EARLY TREATMENT. 

For obvious reasons, when a member of a family becomes 
afflicted with insanity, in many instances, the immediate friends 
fail to recognize the full import of the situation, to the detriment 
of patient, and not until the disease is well advanced are proper 
steps taken for care and treatment. This lethargy or indifference 
is not practised in relation to other diseases ; then, the physician is 
at once consulted, but when mental aberration occurs there is a 
disposition, it may be for social or other reasons, to cover up the 
actual conditions. It is not a little gratifying, however, to know 
that a large amount of the prejudice which has heretofore existed, 
in relation to insanity, is fast passing away, and it is now looked 
upon more as other diseases. When the friends, the public and 
the medical profession look upon mental disease in the same light 
as pathological conditions in other parts of the organism, amen- 
able to the same laws of cause and effect, then, and not until then, 
will mental disease receive the early recognition which its impor- 
tance merits. 

Too often the specialist does not see the case until the symptoms 



180 MEDICAL AND SURGICAL EMERGENCIES. 

are well developed. The friends of the patient fail to comprehend 
the gravity of the situation, or realizing it, are unable to decide 
what course to pursue. I have little doubt but that many of the 
chronic insane now public charges, and forever lost to their friends, 
could have been restored to health had the early symptoms or 
danger signals been recognized and treated. Fortunately the 
immediate danger of death as well as the hope of recovery can 




Fig. 25. Cross section of the spinal cord. 

generally be decided during the first year. If actively and skil- 
fully treated within the first month, 70 per cent, of those attacked 
may be cured, but if not treated until the sixth month of the dis- 
ease only 50 per cent, can be cured, and for each subsequent month 
the ability diminishes. After the first year not more than 10 per 
cent, recover, and after the second year and until the twentieth 
year of the insanity an exceptional recovery may occur. Practically, 
however, insanity may be regarded as having little hope of recov- 
ery after the first year. Seventy-five per cent, of cures in hospitals 
for the insane occur within eight months from the date of admis- 
sion of the patients. 

If there was one lesson more than another indelibly stamped 



MEDICAL AND SURGICAL EMERGENCIES. 181 

upon my mind by institutional experience, it is the fact that the 
curability of insanity largely depends upon its early recognition. 
The longer the delay, the less the chance of recovery. The great 
pathological law which obtains in most diseases has greater sig- 
nificance when applied to insanity. 

Institutional versus home cure and treatment. This is a ques- 
tion of great importance, and intelligent conception of the nature 
and diagnosis of the disease is necessary in order to give valuable 
advice on the subject. The future welfare, and possibly cure, of 
the patient, will depend upon the proper solution of this problem. 
If possible, it may be better for the patient if treatment can be car- 
ried out at home, on account of the popular stigma of insanity and 
loss of standing of those who have been inmates of hospitals for 
the insane. The fact that the patient did not have to go to an 
asylum favors the impression that the trouble was not serious, and 
the popular prejudice towards one upon whom the official seal of 
insanity has been stamped by commitment to an institution for the 
insane, is largely avoided. But, while guarding the interest of 
patient against this popular feeling, the physician has other con- 
siderations that must influence him in his decision. For instance, 
the influence of home treatment upon members of patient's family. 
It is a duty to suffer inconvenience, and even hardships, in behalf 
of sick members of the family ; the obligations are the same when 
insanity occurs, although there is a limit to moral obligations, and 
that limit is reached when the head of the family is jeopardized. 
The financial consideration often settles the question. The ex- 
pense of home treatment is greater unless there are members of 
the family suitable for nurses. Except in very mild cases, one is 
required for the day and another for the night, and a suitable room 
must be provided with doors and windows properly secured. 

Prognosis. The questions will be asked the physician: Will 
the patient survive the attack ? How long before the cure is com- 
plete? If cured, is there likely to be a recurrence of the attack? 
And what will be the state of the patient, will he be able to attend 
to business ? Will he be well enough to live at home ? To be able 
to answer these questions requires extensive experience in mental 
disorders. The prognosis in mental disease at the onset is diffi- 
cult to foretell. It is well to bear in mind that the unexpected often 
happens. A patient may be maniacal today, as in mania transitoria, 



182 MEDICAL AND SURGICAL EMERGENCIES. 

and in a week or a month be clothed in his right mind. A common 
mode of termination is partial recovery with general weakness of 
mental faculties remaining. Probably about one case in four will 
terminate in this way. Our state institutions contain a large per- 
centage of this class, they form what is known as the "working 
gang." The rate of recovery diminishes with age and is slightly 
more favorable among women than among men. It averages from 
thirty per cent, to forty per cent., calculated on admissions in hos- 
pitals for the insane in the United States. By striking an average 
as regards age, sex and form of mental disease, the following esti- 
mate is considered as very nearly the average result to be expected 
in mental disorders : of one hundred persons attacked for the first 
time by insanity, seventy will eventually die insane; thirty will 
recover and die sane ; twenty will recover but will relapse and will 
.be among the seventy to die insane; fifty will not recover at all. 
The hope of recovery diminishes with each successive attack. The 
majority of first recoveries even leave a slight impairment of the 
intellect. It has been estimated that the average life of the insane 
is about twelve years. 



SOME GENERAL CONSIDERATIONS CON- 
CERNING THE GERM THEORY IN 
RELATION TO THE CAUS- 
ATION OF DISEASES. 

Brief Historical Sketch — What Are Bacteria? — The 
Rapidity of Formation — Distribution oe Bacteria — Agen- 
cies Destructive to Bacterial Life — Conditions Necessary 
eor Growth — Infection — Infectious Principles — Sources 
of Infection — Transmission — Where Bacteria are to be 
Found — Infection of Wounds — The Necessity for Per- 
sonal Cleanliness. 

some general considerations concerning the germ theory, 
in relation to the causation of diseases. 

Brief historical sketch. The study of the germ theory, or what 
is commonly known as bacteriology, is said to have its beginning in 
the seventeenth century. Previous to this time, such changes as 
decomposition and fermentation, processes which are familiar to 
everyone, were supposed to originate spontaneously. 

This is, however, not surprising when it is remembered that up 
to this time no instrument had been devised by which such minute 
objects as bacteria could be seen. 

Notwithstanding, even at this early date there were those who 
suspected that decomposition was due to the presence of minute 
animal organisms, though proof of the belief was not at hand. For 
example, if meat be placed in a covered jar so that flies could not 
light upon it, they buzzed about the jar, but no maggots developed 
upon it. They reasoned, therefore, that decomposition which took 
place in meat when exposed to the air was likewise due to the pres- 
ence of some low form of animal life. It was not, however, until 

183 



1 84 MEDICAL AND SURGICAL EMERGENCIES. 

some time afterwards that the suspected organisms were actually 
demonstrated. 

More than a century ago experiments were carried on to prove 
that the processes, putrefaction and fermentation, were due to 
micro-organisms ; for example, it was found that infusions of or- 
ganic matter, such as beef broth, if boiled in a flask and then sealed 
so as to exclude the air, would keep indefinitely without under- 
going putrefaction, whereas, if exposed to the air they speedily de- 
composed. This experiment alone demonstrated the following 
facts, namely, that bacteria may be destroyed by heat, and also that 
bacteria are present in the air. 

While many important discoveries were made during the early 
part of the present century, the most of what is known has largely 
been developed during the last twenty years ; for instance, the re- 
markable work of Pasteur and especially that of Koch, whose 
ingenuity devised special means for the cultivation of bacteria, has 
rendered possible the separation of the different species, thereby 
permitting classification and the study of their peculiar features. 
Two other important factors have contributed in no small degree 
to the wonderful advances made in our knowledge of bacteriology,, 
namely, the perfection of the compound microscope, and the in- 
troduction of aniline dyes by means of which bacteria may be 
stained. 

What are bacteria ? The word bacterium literally means a little 
stick, suggested to the early observers no doubt by the similarity 
of certain larger bacteria to short rods or sticks. Since we gener- 
ally speak of micro-organisms collectively, we employ the term 
bacteria, which is the plural of bacterium. 

Bacteria belong to the lowest order of vegetable life, and it is, 
therefore improper to speak of them as animals, as is sometimes 
done. They receive their nutrition by a process of imbibition, and 
differ, therefore, from the lowest forms of animal life, which may 
receive within them solid particles of matter, and after having ex- 
tracted the nutriment may throw off the extraneous residue. 

If suspended under a microscope, suspended in a drop of water, 
a certain portion of bacteria are observed to be endowed with 
active motion. Thus they will be seen dancing about, turning on 
their long axis, presenting a picture of most marked animation. 
This marked activity can be demonstrated by special staining pro- 
cesses. 



MEDICAL AND SURGICAL EMERGENCIES. 185 



TPIF RAPIDITY OF FORMATION. 

The rapidity with which bacteria multiply is most striking. 
Under favorable conditions the bacterial cell has been observed to 
divide within the space of an hour, or even, in some instances, 




Fig. 28. Front view of the internal organs. 

within twenty minutes. At this rate, if multiplication proceeded 
unchecked, the offspring of a single bacterium would in a few 
days fill up all the oceans of the world. Fortunately, however, 
such rapid multiplication is soon limited by lack of food and by 
various other influences unfavorable to their growth. 

A single germ-cell is invisible to the naked eye, and only when 



186 MEDICAL AND SURGICAL EMERGENCIES. 

masses of them are present can they be seen. For example, in 
gelatine, if the germs are allowed to grow ten or twelve hours, 
small white spots may be observed which consist of masses of bac- 
teria, and each one of those spots or colonies, as they are called, 
may consist of millions of bacteria. 

DISTRIBUTION OF BACTERIA. 

Bacteria are very widely distributed. They are present in water, 
their numbers however depending on the extent of contamination 
with organic matter. All well and spring waters contain bacteria, 
which are known as water bacteria, and which may multiply 
therein, but such bacteria are perfectly harmless, and only when 
such waters are contaminated by the presence of organic matter 
are disease-producing germs found present in them to any great 
extent. The dust invariably contains bacteria which may be wafted 
about by currents. The air of high altitudes, or that in mid- 
ocean, may be comparatively free from bacteria, while that near 
the surface of the earth, especially near human habitations, usually 
contains more bacteria than locations far removed from such 
influences. 

The ground, especially the superficial layers, is the natural dwel- 
ling for a large variety of bacteria. 

The presence of decaying vegetable matter is particularly favor- 
able to bacterial growth, and for that reason, virgin soil, just as 
we would expect, is especially rich in bacteria. 

From the most universal presence of bacteria in the water, air, 
and ground, all objects resting on the earth are more or less con- 
taminated with bacteria. They enter the body with Ihe air we 
breathe, with the water we drink, and the food we eat. From this 
it would seem that we are at the mercy of the hosts of bacteria 
which are constantly about us, and that sooner or later we must 
succumb to their attacks. 

It must, however, be remembered that only a comparatively 
small proportion of bacteria are harmful, that most are innocuous, 
and many are extremely useful, if not altogether necessary for our 
existence. Many bacteria which are found in the ground, the so- 
called putrefying bacteria, are indispensable to plant life, in bring- 
ing about the necessary chemical changes so that decomposing 



MEDICAL AND SURGICAL EMERGENCIES. 187 

organic matter may be utilized by plants, which in turn render 
higher animal life possible. 

The very important process of fermentation is due to micro- 
organisms, as well as are numerous others which are constantly 
being made use of by every housewife. 

On the other hand nature has carefully protected us from the 
inroads of many of the pathogenic bacteria, by which term is 
meant those bacteria capable of producing disease. For example, 
the usual bacteria which produce wound infection cannot penetrate 
the unbroken skin, and therefore as long as they do not gain 
entrance to the body through some wound, they may remain on the 
skin without being harmful. 

CONDITIONS NECESSARY FOR GROWTH. 

The conditions necessary for the growth of bacteria, are the 
presence of organic matter, moisture, a favorable temperature, 
and for most bacteria, oxygen. Most pathogenic bacteria grow 
best at the body temperature, and any deviation from this, until 
extreme degrees are reached, inhibits their growth, but does not 
necessarily destroy them. While moisture is a necessary con- 
dition for their growth, its absence does not necessarily destroy 
them ; on the other hand, many bacteria may remain quiescent in 
the dry state and be distributed through the air, only to grow again 
when this requisite condition is added. 

The process of drying was taken advantage of by the Egyptians 
in the preservation of their mummies, and has long been taken 
advantage of in domestic life in the preservation of meats, fruits 
and vegirtables. 

Most bacteria require the presence of oxygen for their growth, 
the requisite amount being supplied by the oxygen present in the 
air. There are small groups of bacteria which will not grow in 
the presence of oxygen, and these have been termed anaerobic 
bacteria, in contradistinction to those which grow in the presence 
of oxygen, which are termed aerobic bacteria. Even when all the 
requisite conditions are present, as for example, in a favorable 
culture medium, bacteria may after a time cease to grow, and 
may even die out, either from an exhaustion of the soil, a change in 
the reaction of the culture medium, or from the accumulation of 



1 88 MEDICAL AND SURGICAL EMERGENCIES. 

chemical products, which are elaborated by the bacteria in the 
process of their growth. 

AGENCIES DESTRUCTIVE TO BACTERIAL. LJEE. 

Certain agencies are destructive to bacterial life, -among which 
may be mentioned physical, chemical, and vital forces. 

Of physical agencies, the most important are heat and light. AIL 
bacteria and their spores are destroyed by a brief exposure to a 
boiling temperature or its equivalent in dry heat, and many are 
destroyed by a prolonged exposure to a much lower temperature. 
On the other hand, a freezing temperature, as a rule, does not 
destroy bacteria, but only inhibits their growth. Sunlight is very 
destructive to some bacteria, as, for example, the tubercle bacillus. 
Indeed, so sensitive to light is this bacterium that, in order to 
propagate it on artificial culture media, light must be excluded. 

Most bacteria grow best on neutral or slightly alkaline media. 
The presence of a mere trace of acid will absolutely inhibit the 
growth of many bacteria, while the mineral acids in concentration 
quickly destroy all bacteria. 

Various other chemicals have a distinct inhibitory action on the 
growth of bacteria, even when present in the smallest quantities, 
and in greater concentration quickly destroy them. The best- 
known examples are corrosive sublimate, carbolic acid, and the 
salts of silver. Among other chemical agencies might be men- 
tioned the chemical products of bacteria themselves, usually called 
ptomaines and toxines, which are frequently very complex 
chemicals. 

The vital forces which are injurious to bacteria, and which are 
usually spoken of as the resistive power of the body, exist in the 
living cell, the blood, and the lymph, and are beginning to be re- 
garded as very important factors in the combat which is constantly 
being waged between bacteria and the animal organism. 




Ir 






<e& 



Fig. 27. Germ of Diphtheria. 



Fig. 28. Germ of Erysipelas. 









*«*-^ ; >- 



'ie- 






1 ,->.VIK* 




'.£!• 



V Si 



Fig. 29. Germ of Typhoid Fever. 






rt^s j^3^i 



J * 3 






Fig. 30. Germ of Tetanus or 
Lockjaw. 



Fig. 31. Germ of Tuberculosis. 



I89 



190 MEDICAL AND SURGICAL EMERGENCIES. 

INFECTION. 

By the term infection, as applied to the individual, is usually 
understood that process by which bacteria gain entrance to the 
body and produce disease. On the other hand, it is common to 
speak of inanimate objects as being infected when they serve 
merely as the carriers of infection. Thus we speak of an infected 
house, or infected clothing. 

Again, the contagious principle is frequently termed the infec- 
tion. It will thus be seen that the word has been used in a rather 
wide sense. 

The term infectious has often been used to designate certain 
diseases. By an infectious disease is meant one which may be 
transmitted from one person to another without necessarily imply- 
ing direct personal contact with a person suffering from a disease ; 
while by a contagious disease, as the name signifies, is implied a 
disease communicated by direct personal contact. The modern 
interpretation of the term infectious, as applied to disease, signifies 
any disease which may, by any means, be transmitted from one 
person to another; while the term contagious is used in a more 
restricted sense, and is applied only to those diseases which are 
readily transmitted. As an example of an infectious disease might 
be mentioned typhoid fever, while in smallpox we have the best 
example of a contagious disease. According to this interpretation, 
a contagious disease is always infectious, while an infectious dis- 
ease is not necessarily contagious. 

INFECTIOUS PRINCIPLES. 

The infectious principle of a contagious disease is called the con- 
tagium, and is invariably a bacterium, though there still remain a 
number of diseases in which the specific micro-organism has not 
been discovered. 

A person is said to be immune from a certain disease, when, 
after having been brought into contact with the contagium, he is 
but slightly or not at all affected. 

At present we do not know the exact nature of this process. It 
is a well-known fact that in many cases of the contagious diseases, 
as, for example, smallpox, scarlet-fever, measles, and whooping 
cough, one attack protects against another and renders the person 



MEDICAL AND SURGICAL EMERGENCIES. 191 

immune for life. Immunity may be transmitted from the mother 
to the offspring, and is also conferred by artificial means against 
certain diseases. For example, immunity is conferred against 
smallpox by vaccination, and against diphtheria by the serum of 
the blood of an immunized animal. 

As above stated, infection may take place through the respira- 
tory tract, through the digestive tract, or through the skin. It is 
probable that the first two modes of entrance are the most frequent. 
As has been stated, bacteria are universally present in the air, in 
water, and consequently in our food. So that it is not difficult to 
explain the development of the disease, given the necessary pres- 
ence of the specific micro-organism. 

Several factors, however, enter into the question of infection, 
and the mere access of the specific bacteria to the body by no means 
always produces the disease. Thus the invading bacteria may be 
weakened in virulence or gain access only in small numbers ; then, 
again, they may find the soil unfavorable or the resistive powers of 
the body very strong, so that they perish without causing harm. 

Those bacteria which gain entrance through the intestinal tract 
must run the gauntlet of the stomach, which, during digestion in 
health, contains a corrosive fluid highly destructive to bacteria. 

SOURCES OF INFECTION. 

The primary source of infection is always the person suffering 
from the disease. Not all bacteria which are present in the body 
of an infected person are eliminated, but many are destroyed in the 
body during the progress of the disease. 

It is important to bear in mind the channels through which 
bacteria escape from the body, so that they may be destroyed and 
infection of other persons thus be prevented. 

Indeed, such precautionary measures for the prevention of the 
spread of disease are too seldom taken. 

TRANSMISSION. 

In only a comparatively few diseases is the transmission of the 
infection direct from one person to another. Thus, bacteria may 
escape from the body of a person suffering from the disease, as, 
for example, the sputum of a patient suffering from tuberculosis 



192 MEDICAL AND SURGICAL EMERGENCIES. 

of the lungs, which, if allowed to dry, is taken up by the air as 
dust, and is freely disseminated. Such a patient may, in this man- 
ner, become a menace to the household or to an entire community. 
The same may be said of typhoid fever, in case of failure to disin- 
fect the stools, which invariably contain the infectious principle. 
In this instance, however, the bacteria find their way to the soil 
and ultimately to drinking water, through which they gain en- 
trance to the body. It will, therefore, not be out of place to men- 
tion the most important infectious diseases and the channels 
through which the specific bacterium escapes from the body. The 
following diseases are due to recognized bacteria which escape 
from the patient in the following manner : 

Pneumonia is of different varieties due to different micro-organ- 
isms. Lobar pneumonia is due to the pneumococcus of Frankel. 
It escapes through the body through the sputum, and secretions 
from the mouth and nose. Its infectiousness is very slight, and 
the possibility of direct transmission from one person to another is 
doubted by many. 

Influenza is due to a bacillus which is present in the sputum 
and secretions from the mouth and nose. It is highly infectious 
and is probably transmitted through the air. 

Tuberculosis is due to a bacillus which escapes from the body 
through the sputum or by the secretions or excretions from any 
part of the body which may happen to be involved. It is moder- 
ately infectious and may be transmitted from one person to 
another. 

Whooping cough is due to a bacillus which is present in the 
sputum and secretions from the mouth and nose. It is highly in- 
fectious for persons not immune by previous attack. 

Diphtheria is due to a bacillus present in the secretions from the 
throat and nose. It is markedly infectious for children, only 
slightly so for adults. 

Asiatic cholera is due to a spirillum which is evacuated from the 
body through the gastro-intestinal tract, especially the stools. It 
is markedly infectious, and may be transmitted directly from one 
person to another. 

Yellow fever is due to a bacillus. Little is known about the 
manner of its escape from the body. It is very highly infectious 
and is said to gain entrance to the body through the lungs. 



MEDICAL AND SURGICAL EMERGENCIES. 193 

Typhoid fever is due to a bacillus which escapes from the body 
through the secretions, the urine, and especially through the stools. 
Infection gains entrance to the body through the gastro-intestinal 
tract. The disease is only slightly infectious, rarely being trans- 
mitted directly from one person to another, and then only as a 
result of contamination of the hands, which in turn carry the in- 
fection directly to the mouth or to food or to drink. 

Leprosy is due to a bacillus which is present in the secretions 
from ulcers and mucous surfaces. Its infectiousness is not very 
marked, but it may be transmitted from one person to another. 

In the case of eruptive fevers, as measles, scarlet-fever, and 
smallpox, no specific bacteria have as yet been discovered. The 
■contagious element in all these diseases is said to be present on the 
skin, and is thrown off during the process of desquamation. All 
these diseases are highly infectious and contagious. 

The bacteria which concern the surgeon differ from those caus- 
ing infectious diseases in the fact that they invariably gain entrance 
to the body through some wound, whether deliberately made by 
the surgeon, as, for example, operations, or wounds the result of 
.some accidental injury. A certain number of bacteria which gain 
entrance to the body in this manner universally produce a set of 
symptoms so characteristic as to admit of designation as special 
diseases. Among these may be mentioned tetanus, glanders, an- 
thrax, syphilis, and tuberculosis. 

WHERE BACTERIA ARE TO BE FOUND. 

The distribution of bacteria is almost universal. They are pres- 
ent in the air, the water, the ground, and on all objects, for ex- 
ample, our bodies, and utensils of every description are contami- 
nated to a greater or less extent with bacteria. But not all bacteria 
are dangerous or capable of infecting a wound, in fact only a 
comparatively few varieties are known to be dangerous; thus 
drinking water, unless contaminated from some other source, or 
the air from the dust of an operating room, seldom contains the 
bacteria known to infect a wound. Therefore, in order to elimi- 
nate as nearly as possible the danger of infection from these two 
sources, all water to be used at an operation is boiled, and hence 
.rendered sterile, and the operating room is kept free from dust. 
15 



194 MEDICAL AND SURGICAL EMERGENCIES. 

All objects including utensils, instruments of every kind, dressings, 
etc., are more or less infected, and in order to eliminate all source 
of infection, modern surgery requires that they be sterilized be- 
fore use. 

INFECTION OF WOUNDS. 

The most frequent source of infection of wounds is the surface 
of the body, especially the skin and its appendages, the hair and the 
nails. In fact, many of the most active of bacteria of wound in- 
fection are constantly present on the skin, and for certain species, 
the skin seems to be the most natural dwelling, especially the sur- 
face of the body which is constantly exposed, therefore the head 
and face, and especially the hands invariably contain bacteria 
capable of producing infection in a wound. 

Not only the skin, but the mucous membrane lining the nose 
and eyes, the mouth, the intestinal, respiratory and genito-urinary 
tracts invariably contain bacteria capable of producing wound 
infection. 

the: necessity for personal cleanliness. 

Personal cleanliness will to some extent lessen the number of 
bacteria present on the skin, by removing the superficial scales of 
the outside layer of the skin, which are constantly being thrown 
off, but it will not keep the skin sterilized. It was for a long time 
taught and practiced in the leading hospitals in the country that 
personal cleanliness was sufficient to avoid wound infection on 
the part of the operator and nurses, but modern surgery demands 
more than personal cleanliness. Indeed, virulent bacteria have 
been known to persist on the hands for three or four days after 
infection, notwithstanding the most painstaking and repeated 
efforts at disinfection. 

Puerperal infection is generally conceded to belong to the wound 
infections, the same cause producing it as is responsible for 
wounds elsewhere in the human organism, the source of the bac- 
teria being usually outside of the body, being conveyed to the 
points of inoculation by external agents, such as the hands, instru- 
ments, and the like. 

For the avoidance of puerperal infection, the same regulations 
should be carried out as are employed in the provision of infection 
of wounds in any other part of the body. 



FEEDING OF THE SICK. 

Gruels — Oatmeal, Cornmeal, Rice, Farina, Flour — Nourish- 
ing Drinks — Punch, Milk, Rum, Sherry, Hot Milk and 
Water, Egg-Nog, Oatmeal Soup, Beef-Tea, Mutton-Broth, 
Chicken-Broth, Hot Egg-Nog, Egg Water, Egg-Broth, 
Lemonade With Egg, Egg Flip, Lemonade, Corn Tea, Crust 
Coffee, Tea, Coppee, Chocolate — Tapioca Jelly, Sago, 
Arrow-Root, Arrow-Root Milk, Whipped Cream, Corn- 
starch Pudding, Beef Juice, Mint Tea, Cream Soup, Flax- 
seed Lemonade, Irish Moss Lemonade, Barley Water, 
Toast Water, Apple Water, Bran Tea, Wine Whey, Flax- 
seed Tea — Peptonized Foods- — Peptonized Milk, Peptonized 
Gruel, Peptonized Beep-Tea — Suggestions and Rules for 
Diet of Invalids — Fluid Diet. 

gruels. 

Oatmeal gruel. (Time 30 minutes.) One quart boiling water, 
half pint medium oatmeal, half teaspoonful salt. 

Pour the boiling water over the meal, stir it well and strain 
through wire sieve. Boil the liquid which is strained off until it 
thickens and looks clear; if too thick, add the boiling water until it 
is of the desired consistency; add the salt, and, if allowed, two 
tablespoonfuls of sweet cream, which will greatly improve taste. 

Cornmeal gruel. (Time, 2 hours.) One tablespoonful corn- 
meal, quart of boiling water, saltspoonful of salt. 

Sprinkle the meal into the water while boiling, stirring all the 
while to prevent lumps, add the salt and simmer slowly two hours ; 
if too thick, thin it with boiling water. 

Rice gruel. (Time, 2 hours.) Two tablespoonfuls rice, six 
tablespoonfuls cold water, one and a half pints new milk, one tea- 
spoonful sugar, half a teaspoonful salt. 

195 



196 MEDICAL AND SURGICAL EMERGENCIES. 

Wash the rice thoroughly, and soak in cold water one hour ; put 
it in a double kettle with the milk and simmer until the rice is well 
done, then pulp it through a wire sieve and add the sugar and 
salt. 

Farina gruel. (Time, 30 minutes.) One tablespoonful of 
farina, one pint of boiling water, half a saltspoonful salt. 

Sprinkle the farina into the boiling water, stirring all the time 
to prevent lumps, add the salt and simmer slowly half an hour. 
A teaspoonful of cream will improve the taste of the gruel, and, if 
allowed, should be stirred in just before it is removed from the fire. 

Flour gruel. (Time, 30 minutes.) Mix a tablespoonful of 
flour with milk enough to make a smooth paste and stir it into a 
quart of boiling milk. Boil for half an hour, being careful not to 
let it burn, salt and strain. 

VARIOUS NOURISHING DISHES FOR THE SICK. 

Milk punch. To half a pint of fresh cold milk, add two tea- 
spoonfuls of sugar and an ounce of brandy or sherry ; stir till the 
sugar is dissolved. 

Rum punch. Dissolve one teaspoonful of sugar in half a pint of 
milk, stir in two tablespoonfuls of rum, and mix well by pouring 
from one glass to another twice. 

Sherry punch. Put quarter pint of milk into a goblet, dissolve 
one teaspoonful of sugar in it, and add two tablespoonfuls of 
sherry wine. 

Hot milk and water. Boiling water and fresh milk in equal 
parts compose a drink highly recommended in cases of exhaustion, 
as it is quickly absorbed into the system, with very little digestive 
effort. 

Egg-nog, I. Beat the white of an egg stiffly, then stir into it in 
turn, a tablespoonful of sugar, the yolk of an egg, a tablespoonful 
each of ice-water, milk and wine ; do not beat, but stir very lightly. 

Egg-nog, 2. Beat up one egg with a tablespoonful of sugar, 
stir into this a cup of fresh milk, an ounce of sherry, or half an 
ounce of brandy, and a little nutmeg. 

Oatmeal soup. Put two ounces of oatmeal in a basin, pour over 
it a pint of cold water, stir it, and let it stand a minute ; then pour 
over it quickly, stirring all the time, a pint of good broth, pour 



MEDICAL AND SURGICAL EMERGENCIES. 197 

through a fine strainer into a sauce-pan, taking care that none of 
the coarse part of the meal goes into the soup. Boil the soup for 
ten minutes, season and serve. 

Beef-tea. A pound of lean beef should be freed from fat, 
tendon, cartilage, bone, and vessels ; it should be chopped up fine, 
and put in a pint of cold water to digest for two hours. It should 
simmer on the range or stove for three hours, but the temperature 
should not exceed 160 degrees Fahrenheit. The water lost by 
evaporation should be made up by the addition of cold water, so 
that a pint of beef-tea should represent one pound of beef. It 
should be strained, the beef being carefully expressed. A wine- 
glassful every three hours is a suitable quantity for administration 
in ordinary, acute cases. 

Mutton-broth. Lean loin of mutton, one pound, exclusive of 
bone ; water, three pints. Boil very gently till tender, throwing in 
a little salt and onion according to taste. Pour out the broth in a 
basin, and, when it is cold, skim off the fat. It can be warmed up 
as wanted. 

Chicken-broth. Skin, and chop up small, a small chicken, or 
half a large fowl, and boil it bones and all, with a blade of mace, 
a sprig of parsley, and a crust of bread, in a quart of water, for 
an hour, skimming it from time to time. Strain it through a coarse 
colander. 

Hot egg-nog. Beat together the yolk of an egg and a teaspoon- 
ful of sugar, and stir into a pint of milk at boiling point, add' a 
tablespoonful of brandy or whisky, and grate a little nutmeg over 
the top. 

Egg water. Stir the whites of two eggs into half a pint of ice- 
water, without beating, and add enough salt or sugar to make it 
palatable. 

Egg-broth. Beat together one egg and half a teaspoonful of 
sugar, till very light, and pour on a pint of boiling water, stirring 
well to keep it from curdling, add salt, and serve hot. 

Lemonade with egg. Beat one egg with two tablespoonfuls of 
sugar, until very light, then stir in three tablespoonfuls of cold 
water, and the juice of a small lemon, fill the glass with pounded 
ice and drink through a straw. 

Egg flip. Beat one egg and four teaspoonfuls of sugar together 
until stiff and light, pour half a pint of hot beer (not boiling), 



198 MEDICAL AND SURGICAL EMERGENCIES. 

into it, stirring briskly to prevent curdling, and pour it from one 
bowl to another, to make it foamy and light. 

N. B. — This is used when stimulant and nourishment are re- 
quired, and should only be taken in small quantities, unless other- 
wise ordered by physician. 

Lemonade, No. I. Two tablespoon fuls of lemon juice, one table- 
spoonful of sugar, half a pint of ice-water, one tablespoonful 
pounded ice, two thin slices of lemon. Put all in a large goblet, 
and stir until sugar is dissolved. 

Lemonade, No. 2. Two tablespoon fuls of lemon juice, one 
tablespoonful of sugar, half pint boiling water. Put all ingredients 
into a hot bowl, and stir until sugar is dissolved ; drink it hot. 

Corn tea. Parch brown a cupful of dry sweet corn, grind or 
pound it in a mortar, pour over it two cups of boiling water, and 
steep for a quarter of an hour, then strain and add boiled milk 
and sugar. 

Crust coffee. Take a pint of crusts — those of Indian bread are 
the best — brown them well in a quick oven, but do not let them 
burn, pour over them three pints boiling water, and steep for ten 
minutes, serve with cream. 

Tea. Tea should be made in an earthen pot, first rinsed in boil- 
ing water. Allow a teaspoonful of tea to each half pint of water. 
Put in the tea, and after letting it stand for a few moments in the 
steaming pot, add the water, freshly boiling, and let it stand where 
it will keep hot, but not boil, from three to five minutes. 

Coffee. Stir together two tablespoonfuls of freshly ground 
coffee, four of cold water and half an egg. Pour upon them a pint 
of fresh boiling water, and let them boil for five minutes, stir 
down the grounds, and let it stand where it will keep hot, but not 
boil, for five minutes longer. In serving, put sugar and cream in 
the cup first, and pour the coffee upon them. 

Chocolate. Scrape fine an ounce of chocolate, add two table- 
spoonfuls of sugar, and one tablespoonful of hot water ; stir over a 
hot fire for a minute or two, until it is smooth and perfectly dis- 
solved, then pour into it a pint of boiling milk, mix thoroughly and 
serve at once. If allowed to boil after the chocolate has been added 
to the milk, it becomes oily and loses flavor. 

Tapioca jelly. One cup of best tapioca- put to soak with a pint 
of cold water ; when soft put in a saucepan with one cup of sugar, 



MEDICAL AND SURGICAL EMERGENCIES. 199 

the rind and juice of one lemon, a little salt, one pint more water; 
stir until it boils; turn into a mould; set to cool; add one glass of 
wine if desired. 

Sago. Put half an ounce of sago into an enameled saucepan with 
three-quarters of a pint of cold water, and boil gently for an hour 
and a quarter. Skim when it comes to a boil, and stir frequently. 
Sweeten with a dessertspoonful of sifted loaf sugar. If wine be 
ordered, two dessertspoonfuls ; and, if brandy, one dessertspoonful. 

Arrow-root. Mix two teaspoonfuls of the best arrow-root with 
half a wineglass of cold water ; add a pint of boiling water ; put it 
into an enameled saucepan, and stir over the fire for three minutes. 
Sweeten with three teaspoonfuls of sifted loaf sugar. Add either 
a wineglassful of white wine, or a tablespoonful of brandy, if 
permitted. 

Arrow-root milk. Mix two teaspoonfuls of arrow-root with a 
wineglassful of new milk ; add half a pint of boiling milk ; put it 
into an enameled saucepan, and stir over the fire for three minutes. 
Sweeten with a dessertspoonful of sifted loaf sugar. 

Whipped cream. Beat half a pint of fresh, sweet cream with a 
whisk, add a dessertspoonful of very finely powdered loaf sugar, 
and twenty drops of essence of vanilla or any other flavoring; 
when firm it is ready for use, but is much improved by being on 
the ice for an hour or two. 

Cornstarch pudding. One quart of milk, four tablespoonfuls of 
cornstarch, four eggs, one tablespoonful of butter, six tablespoon- 
fuls of sugar. Dissolve the cornstarch in a little cold milk, and, 
having heated the rest of the milk to boiling, stir this in and boil 
three minutes, stirring all the time. Take from the fire, and while 
still hot put in the butter. Set away until cold. Beat the eggs very 
light, whites and yolks separately. Stir the sugar and any flavor- 
ing desired in the yolks and then add the beaten whites, and stir 
in the cornstarch, beating thoroughly to a smooth custard. Turn 
into a buttered dish and bake half an hour. To be eaten cold. 

Beef juice. Broil quickly some pieces of round or sirloin, of a 
size to fit in the cavity of a lemon-squeezer. Both sides of the beef 
should be quickly scorched to prevent the escape of the juices, but 
the interior should not be fully cooked. As soon as ready, the 
pieces should be pressed in the lemon-squeezer, previously heated 
by being dipped in hot water. The juice, as it flows away, should 



200 MEDICAL AND SURGICAL EMERGENCIES. 

be received in a hot wineglass, and, after being seasoned to the 
taste with salt and a little Cayenne pepper, eaten while hot. If 
preferred, the juice may be frozen. 

Mint tea. Put one pound each of beef, mutton and veal, cut 
into small pieces, into three pints of cold water. It should simmer 
for three or four hours, but not boil. When finished, the tea 
should be carefully strained, and seasoned with salt and Cayenne 
pepper, if preferred. 

Cream soup. Take one quart of good stock (mutton or veal), 
cut one onion into three quarters, slice three potatoes very thin, 
and put them into the stock with a small piece of mace ; boil gently 
for an hour ; then strain out the onion and mace ; the potatoes, by 
this time, have dissolved in the stock. Add one pint of milk, 
mixed with a very little cornflour to make it about as thick as 
cream. A little butter improves it. This soup may be made with 
milk instead of stock, if a little cream is used. 

Flaxseed lemonade. Three tablespoonfuls of flaxseed, two 
tablespoonfuls of sugar, one pint boiling water, three tablespoon- 
fuls lemon juice. Put the flaxseed and sugar into a pitcher, pour 
the boiling water over them, and steep on the back part of stove 
one hour, strain, add lemon juice, serve cold. 

Irish moss lemonade. Quarter pint Irish moss, quart boiling 
water, six tablespoonfuls lemon juice, four tablespoonfuls sugar. 
Wash the moss thoroughly and let it soak in cold water ten min- 
utes, then remove all imperfect parts, and any gravel that may 
adhere to it. Put it in a pitcher with all the other ingredients, 
cover closely, and steep on the back part of the stove two hours, 
then strain through a wire sieve, and serve either hot or cold. 

Barley water. Wash two ounces of pearl barley in cold water, 
then boil for three minutes, and throw both waters away, add two 
quarts of boiling water and boil until reduced to one quart — or 
about two hours — stirring frequently, strain, add the juice of a 
lemon and sweeten. 

Toast water. Toast three slices of stale bread to a very dark 
brown, but do not burn. Put into a pitcher, and pour over them a 
quart of boiling water, cover closely, and let it stand on ice until 
cold, strain. A little wine and sugar may be added, if desired. 

Apple water. Slice into a pitcher half a dozen juicy sour apples, 



MEDICAL AND SURGICAL EMERGENCIES. 201 

add a tablespoonful of sugar, and pour over them a quart of boiling 
water, cover closely until cold, then strain. (Slightly laxative.) 

Bran tea. To a pint of wheat bran, add a quart of boiling water, 
let it stand where it will keep hot (but not boil) for an hour, strain 
and serve with sugar and cream. 

Wine whey. Put two pints of new milk in a saucepan, and stir 
it over a clear fire till it is nearly boiling ; then add a gill of sherry 
and simmer it for a quarter of an hour, skimming off the curd as 
it rises. Then add a tablespoonful more sherry, and skim again 
for a few minutes. 

Flaxseed tea. Flaxseed, whole, one ounce; white sugar, one 
ounce ; licorice root, half an ounce ; lemon juice, four tabiespoon- 
fuls. Pour on these materials two pints of boiling water ; let them 
stand in a hot place four hours, and then strain off the liquor. 

peptonized poods. 

The investigations of Dr. Roberts, of Manchester, have been of 
great service in the use of food which has been artificially digested, 
or peptonized food, as Dr. Roberts recommends it to be called. 
Benger's preparation of the natural digestive ferments is used 
extensively and is added to the milk or gruel, as the case may be, 
as follows: 

Peptonized milk. Dilute a pint of milk with a quarter pint of 
water and divide the mixture into two equal portions. Heat one 
portion to the boiling point, and then mix it with the cold portion. 
Now add to this three fluid drachms of pancreatic solution — 
Liquor Pancreatis (Benger) — and about twenty grains of bicar- 
bonate soda, mix well together and set aside in a covered jug, in a 
warm location, under a "cosy" for an hour or an hour and a half. 
Then boil for two or three minutes and serve like ordinary milk. 

Peptonized gruel. It may be prepared from oatmeal, wheaten 
flour, pearl barley, etc., and should be thick and strong and very 
well boiled. Allow the gruel to cool to a temperature so that it 
can be sipped without burning the mouth (140 Fahr.), and then 
to every pint of gruel add two teaspoonfuls of the pancreatic solu- 
tion, and mix well together, pour the whole into a jug with cover, 
and set it aside in a warm place for about a couple of hours. 
Finally boil it for three minutes and strain. 



202 MEDICAL AND SURGICAL EMERGENCIES. 

Peptonized beef-tea. Mix half a pound of finely minced lean 
beef with a pint of water and twenty grains of bicarbonate soda, 
and let the whole simmer for an hour and a half; when it has 
cooled down to the temperature of 140 degrees Fahr., add a tea- 
spoonful of the pancreatic solution and place the mixture in a 
warm place for a couple of hours, stirring it from time to time, 
then strain off without pressure and boil the liquid for five minutes. 

VALUABLE SUGGESTIONS AND RULES FOR'THE DIET OF INVALIDS. 

For general rules for guidance in feeding the sick we copy the 
following from high authority: In acute diseases it is well to 
recommend a special plan of diet ; in chronic cases it is often more 
convenient simply to forbid those articles which are likely to prove 
harmful. Before recommending any article it is well to ascertain 
whether the patient likes it and how it agrees with him. No article 
of food should be forbidden unless one has good reason for doing 
so. Unless there is some strong contra-indication, attention should 
always be paid to the wishes and taste of the patient. This rule 
was first formulated by Hippocrates in the aphorism, "Such food 
as is most grateful, though not so wholesome, is to be preferred to 
that which is better, but distasteful ;" and Sydenham recognized 
its value when he wrote : "More importance is to be attached to 
the desires and feelings of the patient, provided they are not ex- 
cessive or dangerous, than to doubtful and fallacious rules of med- 
ical art." 

If any article of food disagrees it is better to reduce the quantity 
of it taken, before cutting it out of the dietary altogether. Changes 
in diet should, if possible, be made gradually. One should never 
prescribe a diet for a patient without having first ascertained what 
his habits are as regards work and exercise. 

FLUID DIET. 

This is the first diet in fever. It has the advantage of supplying 
water to the tissues, of which they stand in special need in fever ; 
they gratify thirst and do not necessitate chewing, which taxes the 
patient, owing to the diminution of the salivary secretions. Milk 
is the simplest and most available of nutritious liquid foods. It 
should form the basis of the diet. If it does not seem to agree 



MEDICAL AND SURGICAL EMERGENCIES. 203 

with the patient give it in small proportions, and let it be taken 
very slowly and frequently, or modify it by adding water, or some 
alkaline, or effervescing water or lime water. It may be the fat in 
the milk which causes the trouble. In this case it should be 
skimmed. If the patient tires of it change the flavor ; a little cold 
coffee, caramel or malt extract will often be agreeable. The milk 
may be fortified by addition of cream, if easily borne, or by one of 
the carbohydrates, such as milk sugar or a pure gelatine in small 
quantity, or the white of Qgg, or several other food articles well 
known to the physician. Sometimes milk will produce vomiting 
and diarrhea, which makes it necessary to peptonize the milk or 
give kumyss instead. However, restrict the feeding to the plain 
(and if necessary diluted) milk diet, to the patient in bed with 
fevers of short duration, until you find that insufficient to repair 
nutrition. Two quarts a day will meet the demands and some- 
times even a little less in cases where the body can afford to a cer- 
tain extent to draw upon its own resources, and sometimes this 
must be allowed when the stomach is weak and very easily over- 
taxed. 

Soups, beef-tea and broths belong to fluid diet, but are not 
strictly speaking foods. They are slightly stimulating and used 
chiefly to excite the appetite and are grateful to the thirst of the 
patient. These may be given in the proportion of a pint a day. 
When diarrhea is present avoid the use of soups, broth, etc., con- 
taining meat extractives. 



DIET. 

What to Eat and What Not to Eat in Gout, Rheumatism,. 
Neurasthenia, Obesity and Acid Conditions of the Blood 
— List Prepared by an Eminent German Specialist in 
Nervous Diseases and Diseases op the Blood. 

EAT. 

Soups. Bouillon or beef-tea or clam broth occasionally, say 
twice a week. 

Meats. Mutton, lamb, chicken, squab, quail, and sparingly of 
beefsteak, roast beef, but medium weli done. Ham and bacon 
(occasionally). 

Eish. All kinds, broiled, except salmon. Oysters only raw, use 
only lemon juice and salt with them. 

Vegetables. Spinach, asparagus, egg plant, oyster plant, string 
beans, French peas (but tender), celery. Boil all vegetables, mix- 
ing one-fourth ounce bicarbonate of soda in water. Potatoes 
sparingly, either boiled, baked or mashed. 

Fruits. Apples, raw or baked without sugar, oranges, lemons 
(sparingly), pears (sparingly), grapes and peaches. 

Dessert. Light pudding occasionally, such as custard or bread 
pudding. 

Bread. Toast, stale white, stale whole meal, rye or zweiback. 
Crackers, sparingly. 

Beverages. Boiled milk (sparingly), better mixed with lime 
water. Coffee with plenty of boiled milk once a day only. Weak 
tea, with plenty of boiled milk. Buttermilk, kumyss or matzoon. 

Liquors. One ounce whisky diluted, once a day. Women, one- 
half ounce. 

Wines. California white or Moselle (still). Cider. 

204 



MEDICAL AND SURGICAL EMERGENCIES. 205 

Eggs. Soft boiled, poached on toast or hard boiled, but must 
boil twenty minutes or longer. 
Butter. Sparingly. 
Salts. Freely. 

avoid. 

Soups. Rich, spicy, especially clam chowder. 

Meats. Fresh pork, veal, turkey, goose, duck, sausages, chopped 
meats, corned beef, smoked beef. 

Fish. Salmon. 

Oysters. Baked, fried or stewed. Crabs and lobsters, clams 
and shrimps. 

Vegetables. Rhubarb, tomatoes, succotash, corn, cabbage, cauli- 
flower, turnips and carrots. 

Potatoes. Fried and salad, also sweet potatoes. 

Salads. All kinds. 

Fruits. Strawberries and bananas. 

All sugar, vinegar, pastry, cereals, such as oatmeal, rice and 
mush, fresh bread, hot rolls, hot cakes. 

Beverages. Cocoa, chocolate, raw milk, all sparkling wines, 
malted liquors, clarets, all ice cream and especially ice cream soda. 
Eggs. Fried, scrambled, shirred, omelettes. 
Cheese of all kinds. 

Avoid pepper and all spices except salt. 
Catsup and Worcestershire sauce, sour horseradish. 
.Raisins, almonds, nuts. 



WATER AND ITS USE. 

Physiological Effects of Water, Internal — Physiological 
Effects of Water, External — Effects of Cold Water — 
Effects of Warm Water — Manner of Applying — The 
Wet-Pack, the Rubbing Wet-Pack, the Douche — The 
Sitz Bath, Bran Bath, Salt Bath, Mustard Foot Bath — 
The Hot and Cold Compress, Method, Physiological Ef- 
fects — Therapeutic Applications — The Hot and Cold 
Head Compress — The Hot and Cold Lung Compress — The 
Hot and Cold Kidney Compress — The Hot and Cold Gas- 
tro-Hepatic Compress — The Hot and Cold Intestinal 
Compress — The Hot and Cold Pelvic Compress — The Hot 
and Cold Heating Compress or Pack, Physiological Ef- 
fects — The Hot and Cold Chest Bath — The Hot and 
Cold Abdominal Pack, Use in Vomiting^-The Hot and 
Cold Lumbar Pack — The Hot and Cold Spinal Pack — 
The Hot and Cold Pelvic Pack — Special Forms of Com- 
press — The Cephalic Compress, Physiological Effects, 
Therapeutic Applications. 

some remarks on how and when to use water, internal and 

external. 

Physiological effects of water, internal. It need hardly be 
stated that water is an essential constituent of the tissues. 

A certain quantity of water or fluid aliment is necessary to the 
digestive process. An excessive quantity impairs digestion, by 
so far diluting the gastric juice as to render it incapable of dis- 
solving the foods. The free use of cold drinks — ices and iced 
water — seriously disorders digestion. To this state, induced by 

206 



MEDICAL AND SURGICAL EMERGENCIES. 207 

the free use of very cold drinks during meals, or during the time 
of digestion, has been applied the term "ice water dyspepsia," a 
very common malady in the United States. 

A glass of cold water before breakfast will in many persons 
cause a satisfactory evacuation of the bowels. The activity of 
the water is increased by the addition to it of a teaspoonful of 
common salt. 

Although water is essential to the constitution of the fluids and 
solids of the body, there is no doubt that large and frequent 
draughts of water may prove injurious by too great increase in 
the fluidity of the blood, and a consequent damage to the red 
corpuscles. 

Physiological effects of water, external. The influence of 
temperature must necessarily be considered in connection with 
the effects of water when applied externally. 

Effects of cold water. When an extremity — for example the 
hand — is immersed in cold water, the temperature of the other 
hand also falls. Cold water abstracts the heat of the body, at 
least of its superficial surface, and affects the condition of the 
internal organs through the nervous system. 

When a cold bath is entered a marked sense of chilliness is 
experienced, the skin becomes pale and is roughened by the erec- 
tion of the hair follicles, the lips are blue, the breath has a spas- 
modic and catching character, and the pulse is quickened. The 
temperature of the surface is lowered, for the blood accumulates 
in internal organs, and the nerves of the skin are depressed. If 
the temperature of the water be not too low, and if the bodily 
vigor be sufficient to withstand the shock, the condition known 
as "reaction" speedily ensues. The coldness and depression are 
succeeded by warmth and a feeling of exhilaration; the pulse 
quickens, and the respiration becomes easy and unembarrassed ; 
and the muscular strength is increased. If, however, the body 
be immersed for too long a period, the condition of reaction is 
supplanted by coldness, depression, weakened pulse, and muscu- 
lar debility. 

Effects of warm water. The degree of effect which is pro- 
duced by the immersion of the body in warm water is influenced 
by the temperature ; but the quality of the effect is the same at all 
degrees from tepid to hot. The sense of warmth is at first grate- 



208 MEDICAL AND SURGICAL EMERGENCIES. 

;f ul to the feelings ; the skin becomes red from the increased activ- 
ity of its vessels; the pulse quickens in beats, but diminishes in 
tension; the respiration is more frequent; and giddiness, faint- 
ness, and muscular languor, are finally produced, if immersion 
be prolonged or the temperature be too high. 

Manner of applying the water. The water of a cold bath 
should have a temperature of 50 to 60 degrees Fahr. The tepid 
.bath has a temperature of from 85 to 95 degrees, the warm bath 
from 95 to 100, and the hot bath from 100 to 106 degrees Eahr. 

The vapor of water in the form of the Russian bath, steam- 
bath, or warm or hot wet-packing, may be used to accomplish 
the same objects as those obtained by the warm or hot bath. 
Without entering unduly into the details, it will suffice to state 
that the Russian bath consists in the exposure of the body in suit- 
able apartments to the vapor of hot water, at a temperature grad- 
ually increased from 95 to no degrees Fahr. The bath should 
not, under ordinary circumstances, exceed fifteen minutes in 
duration. In order to overcome the relaxing and debilitating 
effects of the bath, one should either enter a cold bath slowly, or 
have cold water dashed over the body. This expedient, conjoined 
with friction of the surface, increases materially the good effects of 
the Russian bath. In the absence of special arrangements for 
.giving the Russian bath, simple means will suffice. The patient 
may sit upon a low stool with a blanket pinned around his neck, 
and under this the vapor of water may be conducted. Or, if con- 
fined to bed, the patient may be placed on a gum-cloth, and the 
blanket may be elevated above him by hoops, arranged trans- 
versely, under which the vapor of water may be conveyed from 
an ordinary tea-kettle. Fresh lime is sometimes used to generate 
hot vapor. The patient is placed on a low stool and. surrounded 
by a blanket. Some pieces of freshly burned lime are then 
dropped into a vessel of water placed under the blanket. The 
slacking of the lime causes great heat, and the consequent gen- 
eration of a considerable quantity of watery vapor, which also 
carries up with it minute particles of lime. The proceeding is 
.said to be especially efficacious in membranous croup and diph- 
theria. 

The wet-pack. This produces the good effects of cold-water 
applications, and consists in wrapping the body in a linen sheet 



MEDICAL AND SURGICAL EMERGENCIES. 209 

wrung out in cold water. The patient should be placed in an 
ordinary single bedstead, on which is a hard mattress covered 
with several thicknesses of blankets or comforters. The sheet 
is dipped in cold water, and, when thoroughly wrung out, is laid 
smoothly on the bed. The patient reclines on the sheet, his head 
supported by a pillow. One side of the sheet at a time is then 
drawn over the patient's body and neatly tucked under the oppo- 
site side, the feet and legs being lifted up and the sheet made to 
entirely envelop them. Some blankets or comforters are now 
closely applied around the body of the patient. There is first 
-experienced a disagreeable sense of chilliness and discomfort, 
which is soon succeeded by a delightful glow. When reaction 
is fully established, the wet-pack should be removed, and the 
body be well rubbed with dry towels. The duration of this 
application should be from fifteen minutes to an hour. 

The rubbing wet-pack. This' is a convenient mode of taking 
the morning bath as a hygienic measure, and also of procuring 
more speedily some of the good effects of the wet-pack as applied 
above. It consists in enveloping the body with a sheet dipped in 
cold water, and rubbing vigorously with the sheet to induce re- 
action quickly. The patient stands up during the application, 
and an attendant rubs those parts inaccessible to the patient. 
When the sheet is removed the skin is dried by the vigorous 
application of coarse towels, and the patient immediately puts on 
liis clothing. 

The douche. This consists in the impact against the body of 
a column of water from a height. No greater height than ten 
feet, and a column not larger than four inches, will be proper -or 
safe under any circumstances. A hose attached to a water-pipe, 
the supply being regulated by a stop-cock, is a convenient method 
of using the douche. In domestic practice a large pitcher or 
water-bucket, if provided with a suitable spout, may be utilized 
for this purpose. The douche may be either cold, tepid or hot ; it 
may have a direction descending, ascending, vertical, horizontal, 
or oblique; and the effect may be regulated by the height from 
which the water is projected, the size of the stream, and the 
force with which it is thrown against the part. As the effect of 
the douche is very great when the water is cold, when the volume 
of the stream is large, and when it is thrown with force, it is 
14 



210 MEDICAL AND SURGICAL EMERGENCIES. 

obvious that care must be used in directing it against the head, 
the chest, and the abdomen. As a. rule, it is too violent a 
measure to be employed in weak and susceptible subjects about 
the trunk, but it may be used freely, of course, on the extremities. 

The sitz bath. This bath may be cold, tepid, warm, or hot, 
as the indications seem to require. The apparatus for adminis- 
tering it consists of a tin or wooden tub of sufficient capacity to 
contain water enough to cover the hips and lower part of the 
abdomen when the patient sits down in it. The tub should have 
a raised back to support the patient, and should be sufficiently 
elevated above the floor, so that the feet may rest comfortably 
when the patient sits down in the water. In the absence of 
special arrangement of this kind, any ordinary washing-tub will 
suffice. The duration should be from five to thirty minutes. 

Bran bath. Put bran enough in a bath to make it milky. This 
bath is used for softening the skin when it is dry and flaky. It 
should never be used in stationary tubs, for in letting off the 
water the bran will be sucked down and will choke the pipe. 

Salt bath. Put in a pound of rock salt to four gallons of 
water; increase salt in proportion to water. This bath is useful 
in invigorating feeble constitutions. 

Mustard foot bath. Mustard foot baths are employed as a 
counter-irritant. To prepare a mustard bath, two tablespoons- 
ful or more of mustard should be tied in a cloth and agitated well 
with cold water ; then hot water may be added to make the bath. 
It is found by experiment that cold extracts the active principle 
far better than very hot does. 

In addition to what has already been said in relation to the use 
of water, and inasmuch as this very valuable remedy is within 
the reach of every one, the following method for its use externally 
will be found very valuable. 

THE HOT AND COU> COMPRESS. 

This procedure consists in the simultaneous and continuous 
applications of a hot and cold compress to separate skin surfaces 
collaterally related to a single internal part. 

This unique procedure is not applicable to all parts of the body, 



MEDICAL AND SURGICAL EMERGENCIES. 211 

but may be applied under appropriate conditions to the head, chest, 
spine, abdomen, pelvis and legs. The hot and cold compress is a 
combined application of peculiar interest and value, since it can 
be relied upon to accomplish, under certain conditions, results 
which can be attained in no other way, and sometimes affords 
relief in cases of great suffering and imminent peril. 

METHOD. 

The adjustment of the hot and the cold compresses respectively, 
varies for different parts of the body and the different viscera, 
the circulation of which it is desired to influence. The manage- 
ment of the cold and hot process should be the same as previously 
indicated for continuous applications; that is, the nervous sensi- 
bility of the cutaneous surface to which the cold application is 
made must be kept alive by rubbing the parts with a dry warm 
flannel for one minute each time the compress is changed. The 
compress should be removed every ten or fifteen minutes, or as 
soon as its temeprature begins to approach that of the body. The 
hot application likewise should be changed every fifteen or twenty 
minutes for a cold application of thirty seconds to one minute, 
so as to empty the veins, restore the tone of the vessels, and to 
prevent too great accumulation of heat in the deeper parts. 

The duration of the hot and cold compress may be from fifteen 
minutes to one or two hours, or even longer. A good rule is to 
continue the application until the desired effect is produced, unless 
decided indications for its interruption appear. 

In the employment of the hot and cold compress it must be 
borne constantly in mind that the application should be made in 
such a way that the blood vessels of the congested organ in the 
interest of which the application is made will be caused to con- 
tract by the cold compress,* the veins or the arteries of the part 
being at the same time drained into another collaterally related 
sub-cutaneous area by means of the hot application, in accordance 
with principles explained elsewhere. 

To secure the best effects, the compresses should be adjusted 
with special relation to internal parts, as explained for each special 
form of this procedure. 



212 MEDICAL AND SURGICAL EMERGENCIES. 

PHYSIOLOGICAL EFFECTS. 

The hot and cold compress is a hydriatic measure of great 
power. It is perhaps the most effective means of controlling the 
movement of the blood in the internal parts. It acts both reflexly 
and derivatively. A cold application applied to one cutaneous 
surface causes contraction of the vessels of the associated internal 
organ through stimulation of its controlling vasomotor centers, 
while the hot compress applied to another cutaneous surface, the 
vessels of which are collaterally related to those of the part, drain 
off a portion of blood into the dilated cutaneous veins and arteries. 
The partial reaction following the first impression made by the 
cold compress and the frequent renewal of the cold application 
facilitates the movement of blood through the affected part, thus 
insuring a constant supply of oxygen and fresh nutrient material, 
the removal of wastes, and the influx of leucocytes, while at the 
same time, the hot application combats stasis by drawing the blood 
into collateral venous and arterial channels, at the same time facili- 
tating the rate of movement of the blood through the arteries of 
the parts by lowering the pressure in the veins. By this combina- 
tion of effects the distension of blood vessels and stasis of blood 
is prevented, while the movement of blood is accelerated, thus 
restoring the normal status of the circulation and greatly facili- 
tating the healing processes. 

THERAPEUTIC APPLICATIONS. 

The conditions under which the hot and cold compress attains 
its special successes are those in which ordinary hot or cold appli- 
cations, if they afford any relief at all, secure no more than partial 
amelioration of the urgent symptom present, the beneficial effects 
which might be obtained through the revulsion produced by cold 
being antidoted by the thermic effects produced by the application ; 
while, on the other hand, hot applications prove too exciting, de- 
pressing the heart when long continued, or causing other un- 
toward effects. By a combination of the two, however, in these 
cases the evil effects resulting from each are antidoted, while the 
good effects are intensified. 



MEDICAL AND SURGICAL EMERGENCIES. 213 

The following forms of the hot and cold compress have been 
tested, and found practical and useful : — 



the hot and cold head compress. 

Place an ice-bag to the back of the neck and the ice compress 
to the vertex. Apply very hot compresses to the face and ears. The 
hot compresses should not extend below the level of the jaw, thus 
avoiding the heating of the large vessels of the neck. The ice-bag 
causes contraction of the vertebral arteries ; the cold compress to 
the vertex causes reflex contraction of the meningeal and cerebral 
vessels, and cools the brain ; while the fomentation to the face and 
ears dilates the external branches of the carotid artery, thus es- 
tablishing collateral anemia of the brain. The fomentation also 
dilates some of the venous channels by which the cerebral sinuses 
are drained. 

A reverse method may sometimes be used advantageously in 
application to the head, as follows : — 

A rubber bag filled with hot water and covered with a moist 
flannel, or a fomentation, is applied to the upper and back part of 
the neck, while a soft cheese-cloth compress wrung out of cool or 
very cold water is applied to the face and the top of the head. 

The effect of the compress in relieving cerebral congestion is 
greatly increased by the application of the ice compress or ice-bag 
to the front of the neck, whereby the blood supply of the brain is 
lessened by contraction of the carotid arteries. 

The combination of heat and cold to the head in this manner 
renders it possible to make applications of heat to the head for 
a much longer time than could otherwise be tolerated, the cold 
antidoting any ill effect which might be produced by the heat, 
while encouraging the good effects of the application. 

The author has made use of this application for many years as 
a means for relieving certain forms of neurasthenic headache. 
It is exceedingly useful also in so-called nervous headache accom- 
panied by marked congestion of the brain. 

This procedure is especially useful in passive congestion of the 
brain, and serves a useful purpose as an adjunct procedure in the 
treatment of insomnia when due to cerebral hyperemia. It should 



2i 4 MEDICAL AND SURGICAL EMERGENCIES. 

be avoided, however, in cases of insomnia due to excessive excita- 
bility of the cerebral cells, and is of course contraindicated in 
insomnia due to anemia. 

THE HOT AND COLD LUNG COMPRESS. 

A thick and very hot fomentation is applied over the back, 
reaching from the middle of the neck to the lumbar region, and 
extending to the axillary line on each side. The cold compress 
should cover the top of the lungs, the lower half of the neck in 
front, and the whole anterior surface of the chest to the level of 
the lower ribs. The fomentation diverts the blood from the bron- 
chial arteries by dilating the cutaneous branches of the inter- 
costals, while the cold compress contracts the bronchial arteries 
through reflex stimulation of the vasomotor centers controlling 
them. The effects of the application may be intensified by hot 
applications to the arms and legs applied simultaneously, especi- 
ally hot packs, which produce decided derivative effects. 

DISEASES IN WHICH THE HOT AND COLD COMPRESSES ARE VERY 

USEFUL. 

This procedure is exceedingly useful in the early stages of 
pneumonia, in broncho-pneumonia, in pulmonary hemorrhage, 
acute pulmonary congestion, and the congestion resulting from 
the use of ether in anesthesia. Its use in the last-named condition 
is especially important when much mucus is present, and when 
cyanosis, or blueness of the skin, indicates stasis from cardiac 
weakness or interference with oxygenation. It has for some time 
been the author's custom to apply a heating chest pack immedi- 
ately after removing the patient from the operating table when 
the foregoing symptoms were present. More recently the plan 
of applying the hot and cold lung compress in cases in which an 
anesthetic is administered has been tested. When ether is em- 
ployed, the application extends to the whole chest surface, as 
above described; when chloroform is used, a hot-bag is .placed 
to the back and an ice-bag or a cold compress over the heart. The 
compress should be at least as large as the surface covered by the 
patient's two hands placed side by side. The cold compress 



MEDICAL AND SURGICAL EMERGENCIES. 215 

should be removed for a few seconds every ten minutes, and the 
surface rubbed with a dry, warm flannel till red, so as to maintain 
the cutaneous reflexes upon which this compress depends for its 
efficiency as a cardiac stimulant. 

EONG EXPERIENCE JUSTIFIES THE USE OE THE HOT AND COED PACK. 

The author has made use of the hot and cold chest pack for ten 
years or more and believes it to be one of the most valuable of all 
means for combating pulmonary congestion. The circulation of 
the lungs is controlled by the vasomotor centers located at the 
upper portion of the dorsal region, and the purpose of the hot 
application is to stimulate the activity of these centers ; while the 
cold application to the anterior portion of the chest causes first a 
contraction, and later active dilatation and fluxion of the vessels 
of the lungs, thus combating passive hyperemia and inflammation. 

This is an excellent means of relieving acute congestion of the 
lung in pulmonary hemorrhages, and combating the hypostatic 
congestions which occur in fevers of a low type. The application 
may be continued for half an hour or more, and should be repeated 
two or three times a day. 

This measure is of very great value for removing the pulmo- 
nary congestion which follows ether anesthesia, and thus combats 
the tendency to bronchial pneumonia, which is often a greater risk 
in old subjects than the operation itself. 

A special form of the hot and cold compress is of particular 
service in asthma. An ice compress is applied to the back of the 
neck and head while a fomentation is applied to the whole front 
part of the chest, extending from the clavicles to the umbilicus. 
The back may be included. The cold application lessens the blood 
supply of the medulla, and so diminishes the excitability of the 
respiratory centers, while the fomentation relaxes the spasm of 
the bronchioles. 

THE HOT AND COED KIDNEY COMPRESS. 

The hot application covers the back from the middle dorsal 
region to the coccyx. The cold application should consist of an 
ice-bag or a cold compress covering the lower third of the 



216 MEDICAL AND SURGICAL EMERGENCIES. 

sternum. The connection of the portal circulation with the renal 
vein makes it undesirable that any of its outlets should be closed 
or its tension raised by reflex impressions from the general ab- 
dominal surface. The fomentation diverts the blood from the 
branches of the lumbar artery which are distributed to the capsule 
of the kidney, and leads off a portion of the blood from the renal 
vein into the anastomosing muscular branches, while the cold 
application causes reflex contraction of the blood-vessels of the 
kidney and increases its activity^ 

This measure is of special service in cases of acute congestion 
of the kidney, especially in connection with acute febrile diseases, 
as scarlet fever, typhoid fever, small pox, and diphtheria. It 
should be used in connection with the hot blanket pack or other 
general hot applications in the intervals as a means of continuing 
the effect of the general hot application. Care should be taken 
that the patient does not become chilled by the cold application. 

The: hot and cold gastro-hepatic compress. 

This compress influences not only the stomach and liver, but 
also the spleen and the pancreas through the intimate association 
of the circulation of these organs. The application is almost 
exactly the reverse of that of the renal compress. The fomenta- 
tion is applied anteriorly from the fourth rib to the umbilicus, 
extending to the axillary line on each side, while a cold bag at 
least eighteen inches long is applied to the dorsal and lumbar 
spine. Through the dilatation of the branches of the internal mam- 
mary arteries and associated veins, the blood is drawn off from 
the stomach, liver, spleen, and pancreas, while the reflex stimula- 
tion of the controlling vasomotor centers contracts the vessels of 
the arterial circulation. 

the: hot and cold intestinal compre:ss. 

The cold compress is applied over the whole abdominal surface, 
extending from the xyphoid cartilage to the pubes. The fomen- 
tation is simultaneously applied to the lumbar region and the left 
side, as it is desirable to divert the blood from the left kidney both, 
by establishing collateral hyperemia of the overlying structures, 



MEDICAL AND SURGICAL EMERGENCIES. 217 

and also by diverting the venous blood from the kidney into the 
anastomosing muscular channels. 

This procedure is of special value in chronic duodenitis and 
colitis. 

THE HOT AND COLD PELVIC COMPRESS. 

The cold compress is applied to the hypogastrium in combina- 
tion with a fomentation across the lower part of the back. The 
fomentation may also profitably become a hip pack, or a hot leg 
and hip pack. When the inflammation is confined to one side, an 
ice-bag instead of the cold compress may be placed over the 
affected part. The ice-bag may be used in combination with the 
hot pelvic pack. 

This measure is especially valuable in the treatment of acute 
inflammations of the uterus, pubes, ovaries, and bladder, in ap- 
pendicitis and pelvic peritonitis. In cases of inflammation of the 
prostate, in proctitis, and cystitis, the ice-bag may be applied to the 
perineum in connection with the hip pack, or with the hip pack 
and the hot leg pack or foot bath applied simultaneously. 

THE HOT OR COLD HEATING COMPRESS OR PACK. 

This procedure differs from the hot and cold compress in the 
same way in which the ordinary heating compress differs from the 
cold compress. In the hot and cold compress the hot application 
is made continuous, or practically so, by the frequent renewal of 
the compress. In the hot and cold heating compress or pack the 
cold application is not renewed, but allowed to accumulate heat 
through reaction. The area covered by the cold application in 
this procedure is usually much greater than in the hot and cold 
compress. The duration is usually from one to two hours. 

This procedure is especially applicable to the chest, the abdomen, 
and the pelvic region. 

PHYSIOLOGICAL EFFECTS. 

The hot and cold pack is, next to the hot and cold compress, 
perhaps the most powerful of all known means of controlling the 
movement of blood through the viscera of the chest and abdomen. 
The heating pack depends for its special features upon the ana- 



218 MEDICAL AND SURGICAL EMERGENCIES. 

tomical fact that the collateral relation between the arteries and 
the veins with internal parts does not closely coincide as regards 
the location of the related vessels in the skin, thus making possible 
the simultaneous application of two procedures differing in 
method, but each assisting the other. 

The explanation of the effects of the hot and cold compress 
applies only in part to the hot and cold heating compress or pack. 
In the former, the action of the cold application is continuous or 
nearly so, while in the heating process the stimulant effect of the 
cold soon disappears, giving place, under the influence of the 
powerful reaction, to extreme dilatation, and great activity of the 
cutaneous vessels. As the heat accumulates, venous stasis is de- 
veloped, producing powerful derivative effects upon the associated 
venous trunks, and thus by lessening the pressure in the veins, 
hastens the movement of blood through the arteries of the con- 
gested part. At the same time, the hot compress, being applied 
to a cutaneous area, the arteries of which are collaterally related to 
those of the deeper structures which it is designed to influence, 
produce powerful collateral anemia of the vessels of the congested 
organ. Several very powerful therapeutic factors are thus 
brought to bear simultaneously upon the diseased part, as follows : 

1. By the application of the cold compress the vessels of the 
part are made to contract, thus forcing ^the stagnating blood on- 
ward into the veins. 

2. As the heating compress warms and the cutaneous veins 
become filled with blood, the veins of the congested viscus are 
emptied, thus draining the tissues of the toxins which have 
accumulated in them. 

3. By lowering the pressure in the veins, the arterial circulation 
through the affected part is facilitated, thus encouraging the 
nutrition and functional activity of the cells which are engaged 
in combating living germs, or which are seeking to repair damages 
which may have originated in any way. 

4. The hot application diverts the blood into the cutaneous 
branches of the collateral arteries or into anastomosing vessels, 
thus preventing undue accumulation of blood and consequent em- 
barrassment of the affected tissues. The anatomical relationships 
through which these results are attained have been described 
elsewhere. 



MEDICAL AND SURGICAL EMERGENCIES. 219 

the: hot and cold chest bath. 

The chest pack is applied in the ordinary way. The form known 
as the square chest pack is preferable. After the wet pack has 
been adjusted and before the woolen wrapping is arranged, a 
spine bag filled with water as hot as can be borne safely (140 
to 160 ) is applied between the shoulders, reaching from the lower 
cervical to the lumbar region. The woolen wrapping is then 
brought snugly in place, and fastened in such a manner as com- 
pletely to cover the back, leaving no openings about the neck. 

The hot and cold abdominal pack. 

In this procedure the moist bandage is placed around the trunk 
at the level of the umbilicus in the usual manner for wet girdle. 
A rubber or aluminum coil is placed upon a wet towel just over 
the epigastrium. The blankets are then tucked snugly around the 
patient, and a stream of hot water is kept flowing through the coil 
continuously during the application, at a temperature as high as 
the patient can bear. The author has made use of this application 
ever since it was first suggested by Professor Winternitz, using 
instead of a coil, however, a rubber bag filled with very hot water, 
a thermophore, or a syphon sack. 

use: in vomiting. 

The hot and cold abdominal pack has rendered most valuable 
service in a great number of cases; and so positive and satis- 
factory have been its results in the hands of the author, that in his 
estimation it stands almost unrivaled as a hydriatic procedure in 
the certainty with which it produces the effects expected from it. 
This measure has proved especially successful in both sensory 
and motor disturbances of the stomach, especially in cases in 
which the patients complain of pain soon after eating, flatulence, 
eructations and regurgitations of food and vomiting of bile. 

In one case in which a lady had suffered four months from re- 
gurgitation of bile into the stomach, being reduced to a very low 
state, the reflux of bile was at once controlled by the application of 
this pack. It was applied half an hour before each of the two 
daily meals given the patient, and was retained two hours, so that 



220 MEDICAL AND SURGICAL, EMERGENCIES. 

the process of digestion was begun under the influence of the 
pack. During the first few weeks of the treatment the difficulty 
returned occasionally when the compress was omitted, but after 
a few months, the patient was able to dispense with the pack, and 
was not only entirely relieved of the distressing symptom, but 
had gained twenty-five pounds in flesh, and was restored to health.. 
In another case a man had been afflicted for years in the same 
manner, having frequent attacks, lasting for several weeks, during 
which time vomiting occurred within a few minutes after each 
meal. The patient was taken to the Battle Creek Sanitarium in an 
extremely feeble condition. The hot and cold abdominal com- 
press, however, controlled the vomiting in a few days, and the 
patient's stomach was soon trained to the digestion of a reasonable 
amount of wholesome and simple food. Scores of similar cases 
might be related. 

Extreme nervous conditions of the abdominal sympathetic and 
of the solar plexus, also require the application of this powerful 
analgesic procedure. By its daily application for a few weeks, 
cases in which the ganglia are so sensitive that even very slight 
pressure excites almost excruciating pain, and in which as a re- 
sult the abdominal viscera are subject to painful affections of 
various sorts, may often be made completely comfortable, other 
constitutional measures being of course employed at the same 
time. In nervous asthma and disturbances due to disorders of the 
abdominal sympathetic, this measure renders invaluable service, 
as may be also noted in the majority of cases of nervous head- 
ache, or migraine, which is likewise a sympathetic nerve disorder. 
Obstinate vomiting, nausea, including the nausea and vomiting 
of- pregnancy, yield to this procedure with the most satisfactory 
readiness in nearly all cases. 

The hot and cold trunk pack has been found of great service in 
cases of hyperpepsia and in hypopepsia attended by gastric 
irritation. 

THE HOT AND COLD LUMBAR PACK. 

This application is made the same as for the hot and cold 
abdominal pack, except that the hot bag or coil is applied over 
the lumbar region. A large square bag is used for this purpose. 
This application is of special service as a means of combating 



MEDICAL AND SURGICAL EMERGENCIES. 221 

portal or renal congestion. Care must be taken to apply the heat 
over the left kidney, as there is a direct communication between 
the left renal vein and the portal system. 

THE HOT AND COLD SPINAL PACK. 

A half sheet, one thickness, wrung out of very cold water, is 
placed about the trunk in the usual manner for the trunk pack. 
The patient then rolls to one side, and a long rubber bag half 
filled with hot water is placed in such a position that when he 
returns to the dorsal position, the bag will lie in contact with the 
center of the back its whole length. The blankets are then drawn 
around the patient in the usual manner. 

This procedure is especially valuable in cases of spinal irrita- 
tion which are aggravated by cold applications, and in which 
there is general passive congestion of the viscera of the chest 
and abdomen, — conditions present in a large proportion of cases 
of chronic dyspepsia, especially in women. In these cases there is 
generally an exceeding tenderness of the lumbar ganglia, of the 
intercostal nerves, and of the whole dorsal region. Hot applica- 
tions to the spine usually afford temporary relief, but are ex- 
hausting and weakening when long continued or often repeated. 
Much better results are obtained by the application of heat and 
cold as described. 

the: hot and cold pelvic pack. 

This measure is applied in the same manner as the ordinary 
cold pelvic pack, with the exception that a rubber bag rilled with 
riot water, or a coil is placed over the lower abdomen next the 
wet sheet. The effect of this application is to afford relief in 
congestions of the pelvic viscera, in which it is as useful as is the 
hot and cold abdominal pack, in congestions of the abdominal 
viscera. 

METHOD. 

The mode of application is precisely the same as that of the 
ordinary pelvic pack, except that a hot water bag or coil is slipped 
in between the folds of the blanket with one thickness intervening, 
and so placed as to fall over the uterus and bladder. 



222 MEDICAL AND SURGICAL EMERGENCIES. 

THERAPEUTIC APPLICATIONS. 

The hot and cold pelvic pack is indicated in hyperesthesia of 
the uterus, ovaries, and bladder, in acute congestion of any of the 
pelvic viscera, accompanied by pain or muscular spasm, as tenes- 
mus of the bladder or rectum, and vaginismus. Painful ovarian 
congestion, congestion and hyperesthesia of the uterus, vesical 
irritation, ovarian irritation, — these and other like conditions in- 
dicate the employment of this useful measure, and are generally 
very readily relieved by it. Sexual erethism, irregular and pain- 
ful menstruation, and the heaviness and indescribable but dis- 
tressing symptoms with which so many invalid women suffer, yield 
to this remarkably efficient measure. 

SPECIAL FORMS OF COMPRESS. 

In addition to the various forms of compress which have been 
described in the foregoing pages, there are several special com- 
presses worthy of description because of their great practical 
utility, and concerning which there are various practical points 
which need to be understood, especially in relation to the tech- 
nique of their application. These are the cephalic compress, the 
chest pack, the throat compress, the neck compress, the joint com- 
press, the cotton poultice, the hip pack, the pelvic pack, the leg 
pack, the foot pack, and the hot and cold compress. 

The roller compress consists of a long strip of cheese cloth 
folded to three thicknesses, and of proper width. Thus prepared 
the bandage is rolled up. When wanted for use, it is immersed, 
wrung out quickly, and applied as soon as possible, so that its 
temperature may not be modified by contact of the air of the room. 
A number of such bandages of different widths should always 
be in readiness for use. 

THE CEPHALIC COMPRESS. 

The application is usually made to either the top or the back of 
the head. When applied to the back of the head, the upper part 
of the neck is usually included in the application. The applica- 
tion may be made to the top of the head and the face, to the face 
and the neck, or to the entire head, — scalp, face, and neck. 



MEDICAL AND SURGICAL EMERGENCIES. 223 

In the application of the cold cephalic compress it is necessary 
to bear in mind the fact that a cold application to the face may 
have the effect to produce collateral hyperemia of the brain, by 
contracting the external branches of the carotid artery. A napkin 
moistened with ice-water and laid upon the forehead may do more 
harm than good, by contracting the supraorbital branch of the 
internal carotid, and thus diverting more blood into its internal 
branches in the cerebrum. This effect may be readily antagonized 
by a cold application about the neck, which will contract the caro- 
tids and the vertebral arteries and all their branches, and thus aid 
the reflex action from the face and scalp in lessening the volume 
of blood in the brain. 

These contrary and undesirable effects of cold applications are 
most likely to occur in conditions in which the vascular tension is 
low and fluctuating. They may give rise to local or circumscribed 
cyanosis from vascular spasm, and simultaneous collateral con- 
gestion. 

In making cold applications for the relief of cerebral congestion, 
special care should be given to the eyes. The compress should 
always cover them, and should be well pressed down upon them, 
so as to utilize the powerful reflex relations which exist between 
the eye and the brain through the sympathetic. 

The same principle governs applications to the hands and feet 
for relief of inflammatory conditions, involving deep structures. 
An ice-bag over the trunk of the artery supplying axilla, bend 
of elbow, groin, popliteal space will lessen the local congestion, 
as well as or even better than an application to the whole arm or 
leg ; while an application to the part alone might produce collateral 
internal congestion. 

PHYSIOLOGICAL EFFECTS. 

The effects of the application of cold to the head have already 
been considered. It may be mentioned further that the head 
compress is less exciting and more sedative than the cephalic 
douche. Applied continuously, or frequently renewed, the pro- 
longed cold head compress is highly sedative, lessening the cere- 
bral blood supply, and diminishing the activity of the brain. In 
active congestion, a continuous very cold application is best ; in pas- 
sive congestion, it is better to secure vasomotor exercise and fluxion 



224 MEDICAL AND SURGICAL EMERGENCIES. 

of the brain by means of the repeated impressions obtained by 
frequent renewals of the cold compress, allowing only time for 
the beginning of reaction effects or slight warming of the com- 
press. 

The short cold compress increases the cerebral blood supply by 
reflex reaction effect. 

The hot or warm cephalic compress, or fomentation to the head, 
congests the cerebral vessels when long applied. 

A short hot application acts by revulsion to diminish the blood 
supply of the deeper parts. 

THERAPEUTIC APPLICATIONS. 

All forms of cerebral congestion, insomnia from cerebral hyper- 
emia, the delirium of infectious fevers, and congestive headache, 
require the cold head compress. 

The hot head compress, or fomentation to the head, excites 
cerebral activity, and is of great service in anemia in syncope, 
shock, and in collapse from any cause when associated with 
cerebral anemia. 

The short cold compress, followed by drying and rubbing of the 
scalp, may be used in the same conditions. The hot compress is 
to be preferred when pain is present, because of its powerful and 
revulsive and analgesic effects. 

Continuous cooling of the head may be secured by wetting the 
hair and allowing the head to remain uncovered. This mode of 
cooling, however, as also the use of the evaporating compress, is 
likely to give rise to rheumatic pains of the scalp, because of the 
long continued action of a degree of cold sufficient to chill by 
slow abstraction of heat, but not vigorous enough to induce re- 
action. The pain is doubtless due to disturbance of the blood sup- 
ply of the nerve trunks. 

The ice-bag applied to the back of the head is a valuable meas- 
ure in spermatorrhea accompanied by frequent losses. The appli- 
cation should be prolonged. It should be applied before going to 
bed at night, being so adjusted as to rest against the base of the 
skull while the patient is asleep. In vaginismus, and in mastur- 
bation in women, due to sexual erethism, the ice-bag may be 
applied with advantage to the upper cervical for twenty minutes 
several times a day. 



MEDICAL AND SURGICAL EMERGENCIES. 225 

In anemic headache, the ice-bag may be applied to the upper 
part of the neck for one to three minutes. The reaction following 
increases the supply of blood to the brain. In nervous asthma, 
prolonged applications of the ice-bag to the back of the head will 
be found advantageous. For very rapid beating of the heart, 
apply the ice-bag for ten to twenty minutes to the back of the 
head or to the neck. A precordial compress should be applied at 
•the same time. 

Many of the above suggestions were taken from the lectures of 
Dr. J. H. Kellogg of Battle Creek, Mich., who is a valuable au- 
thority on this subject. 
15 



THE HAIR. 

Color — Thickness — A Proper Brush and Comb — The Hair 
of Adults — What to Wash the Hair With — Cutting of 
the Hair — Treatment of Ladies' Hair — Don't Crimp and 
Curl the Life Out of the Hair — Blanching or Turning 
Gray — Albinism — Sudden Blanching of the Hair — 
Causes — Capt. Markham's Experience — Treatment for 
the Loss of Hair — Common Baldness — The Restorative 
of the Hair — Dyeing the Hair — Some Vegetable Formu- 
las for so Doing and How to Apply Them. 

The rapidity with which hair grows is subject to great varia- 
tions, even among individuals of the same race. It is influenced 
greatly by the health of the individual, his occupation and age; 
in the young and middle-aged the growth is most rapid, and the 
same condition is seen in those living an active, outdoor life in 
preference to an indoor or sedentary one. The growth of the 
beard is undoubtedly accelerated by frequent shaving, and in a 
minor degree the cutting of the head hair has the same effect. A 
thorough stimulation of the scalp by rapid brushing morning and 
night is also conducive to the lengthening of the hair. 

color of the hair. 

It has been found that the human hair contains three colors; 
yellow, red and black, and that all shades are produced by a 
mixture of these three colors. In the pure golden-yellow hair, 
there is only the yellow pigment ; in the red hair the red pigment 
is mixed with more or less yellow, producing the various shades 
of red and orange. In black hair the black is always mixed with 
yellow and red, but the latter are overpowered by the black. 

A fine head of hair has, in all ages of the civilized world, been 

226 



MEDICAL AND SURGICAL EMERGENCIES. 227 

looked upon as an essential element to beauty. While it is not 
possible for every person to have an exuberant growth of head- 
hair, or of the beard, it is possible, with proper care and attention, 
for all to be the possessors of a respectable hirsutic covering. To 
secure this, in its greatest degree, the hair should receive proper 
attention and care, from infancy up. Campbell, though a poet, 
recognized this fact, for he says in one of his poems : 

"To form a head of beauteous hair, 
Children claim our greatest care." 

"Cleanliness is next to Godliness," is an old aphorism, that 
might, to suit hirsutic hygiene, be changed so as to read "Cleanli- 
ness insures a good head of hair." Many parents are loath to 
wash or cleanse their children's heads. I often see babes in arms, 
with a thick, scurvy crust upon the scalp, through .the neglect of 
the parents to insure proper cleanliness of the child's head; this 
crust, being left on for a time, irritates the skin, and an eczematous 
eruption ensues, giving us our scald-head, as it is popularly called. 
This condition of affairs should not be allowed to take place, and 
it would not, if proper attention were paid to the child's scalp. 
Washing the baby's head in lukewarm water, with castile soap, 
twice or three times a week, or oftener if necessary, should be 
practiced from birth up; then a daily brushing of the scalp and 
hair should be made. For a very young infant the softest brushes 
only should be employed; a rather harsh one to be used first, to 
loosen the dirt, dried sebaceous material, and epithelial scales 
from the scalp, and to brush it out, and then a soft, fine brush to 
polish the hair and make it lie smoothly upon the child's head. A 
fine comb should not be used on a child's head, and a coarse one 
would be of no special use except to part or lay the hair. 

A PROPER BRUSH AND COMB. 

I 

1 In the purchase of a brush or comb, care should be exercised 
to see that a properly manufactured one is selected. It may 
seem like a little matter to attempt advice on so seemingly unim- 
portant a subject, yet a great deal really depends upon it. "For 
want of a nail," you know, "the shoe was lost ; for want of a shoe 
the horse was lost ; and for want of a horse the officer was over- 



228 MEDICAL AND SURGICAL EMERGENCIES. 

taken and slain by the enemy." So, ioo, if you get a hair-brush 
or comb, with slivery bristles or teeth, or teeth too sharp, the scalp 
will be scratched by the one and the hair will be broken with the 
use of the other. 

A proper brush is one made up of fine bristles, varying with the 
individual as regards the stiffness of them. The clusters should 
be evenly set into the back, equidistant from each other, so that 
the whole surface of the scalp, to which it is applied, will be 
touched by some one of the bristle bunches. Then the clusters 
should be made up of bristles of slightly unequal length, so as to 
still farther favor the brush in covering every portion of the scalp ; 
by this means every hair will be rubbed down on all sides, and 
there will be no streaks or spots of the scalp left untouched. 

A proper comb is one whose teeth are even and regular, with 
points not sharp, but rounded. It should be held up to the light 
so as to detect any splitting, or roughening of the teeth on the 
sides, for if they are so roughened, injury to the hair, through 
breakage of the shaft, will surely result. Should the teeth, through 
any cause become so split, as you value your hair, the offending 
members should be carefully cut from the comb ; the slight space 
of the scalp that would thus remain untouched would be of no 
moment, as the comb is not an article that is used for cleansing 
purposes, as is the brush. 

A word might properly be said here on the wire brushes now in 
use. In action they are really a comb, nothing more, nothing less. 
As to their promulgated virtues of magnetic influence on the 
scalp and hair, why, this is all nonsense. They are no better than 
a metal comb would be. However, as a stimulator of the scalp — 
that is by the friction of the teeth upon the scalp-surface a glow 
may be produced — if not used too harshly, they work very well, 
though are not equal to a good bristle brush. 

THE HAIR OF ADULTS. 

- Men, as a rule, are more negligent of their scalps than the 
opposite sex, probably because it is so little bother for them to 
arrange the hair, that they overlook the brushing and washing of 
the scalp almost entirely. Now, the adult scalp should be 
thoroughly washed as often as once a month, at the very least ; a 



MEDICAL AND SURGICAL EMERGENCIES. 229 

daily brushing will not suffice ; brushing does not remove the oily 
particles from the scalp, except when dried down with dust and 
the scarf-scales of the skin. 

WHAT TO WASH THE HEAD WITH. 

One of the best cleansing substances I know of, for either male 
or female use, is the yolk of an egg. This should be well rubbed 
into the roots of the hair and upon the scalp ; then the whole 
washed out with tepid water and castile soap, rinsing with clear 
cold water. This done, it should be thoroughly dried by brisk rub- 
bing with towels, so as to get a roseate glow to the scalp, thus 
bringing a larger supply of blood to the hair papillae ; if found too 
dry a little pomade could be applied. The cocoanut oil is probably 
the best of any. Among the proprietary preparations Burnett's 
Cocoaine is probably the best, as it is made up almost entirely of 
cocoanut oil. Purified beef's marrow could also be made use of, 
though vegetable oils are the best to use, as they are less apt to 
become rancid than the animal oils. 

TREATMENT OF LADIES' HAIR. 

The general principles just announced should govern the ladies 
in the care they bestow upon their hirsute treasures. As they 
have from forty to one hundred miles of these possessions, it 
naturally follows that the care devolving upon them, for keeping 
them in proper healthful order, is greater than upon men. Still, 
wig-makers would ply less of a vocation if the few hygienic 
measures I have given, and those that follow, were heeded. As 
"fashion rules the world to a great degree," I cannot really ex- 
pect that all of this advice will be very closely heeded. Yet, the 
hair should be brushed, rather than combed, daily; its "tangles" 
carefully unraveled, its split ends cut off, and when done up, it 
should be bound in as easy rolls and coils as possible ; one reason 
for this is to allow as free ventilation as possible for the scalp, 
the other, that you may not break the hair or strain the roots, by 
tight tension upon them. Many a lady has lost a luxuriant head 
of hair by persisting in crimping it closely to the head, then bind- 
ing it in coils, as tightly down as possible, thus severing the con- 
nection (partially it may be) of the hair bulb from its living 



230 MEDICAL AND SURGICAL EMERGENCIES. 

papilla at the bottom of the hair follicle, when death to the shaft 
is sure to result. 

don't crimp and curl the hair to death. 

Again, don't crimp or curl it to death. Hair was never intended 
to sleep in worse than a straight- jacket — crimping irons — nor to 
be broiled or steamed on a curling-tongs that bear the temperature 
of the gridiron on which Biddy broils a steak. You must not 
blame your hair for rebelling at this cannibalistic treatment, in 
the way of becoming irremediably stiff, harsh, wiry, broken and 
stunted in its growth. 

Don't bleach it out of its healthy color (should brown hair be 
the fashion when nature has made yours brown or black) by the 
use of strong caustics. You might as well try to bleach the 
healthy color from your lips, by unhygienic procedures, and then 
expect health to remain. The hair-bulb itself keeps pretty close 
watch on your maneuvers, and if you get to carrying your pro- 
ceedings too far, ends up by tossing it all off from your head — 
about the same line of treatment your stomach adopts for ridding 
itself of a late supper of green cucumbers, lobster salad, fried 
oysters and fruit cake. After a time you may get your hair all 
back again, when so lost, but it is never so healthy and thrifty as 
before. 

BLANCHING OR TURNING GRAY OF THE HAIR. 

Hair turning gray is really but a process of living animal decay, 
which we call "the decline of the aged." As regards the scalp, 
the tone of the blood-vessels and nerves is lessened, and hence 
perfect hair-cell growth, either of coloring or formative matter, 
is impossible. The final result of all this is a gradual blanching of 
the color of the hair. Light hair is slower to make this change 
than the darker colored, from the fact that a maximum amount 
of coloring matter was never secreted, and hence the papillae and 
pigment-making materials are not so soon exhausted. 

Usually the beard is the first to show the approach of age, turn- 
ing gray at its upper portion, near the ears, first of all. At about 
the same time the hair, over the region of the temples, begins to 
show the presence of "silvery locks." Creeping therefrom, the 



MEDICAL AND SURGICAL EMERGENCIES. 231 

whiteness extends up to the crown of the head, and down to the 
forehead, and with this there is apt to be a gradual loss of hair. 
Yet, by no means should it be understood that because the hair 
is gray it is always of lessened vitality, since for years it may 
grow as strong and luxuriant as when of brown or raven hue. 
The upper portion of the papilla, or that which gives the coloring 
cells to the hair shaft, is undoubtedly the seat of disease in these 
cases; the lower portion remaining free, of course the formative 
cells of the hair shafts are furnished in normal quantity, and 
hence the shaft preserves its growth in length. 

The cause of the growth of white hair after burns of the scalp, 
or quite severe local inflammations, both in man and animals, is 
explainable on this same basis. The burn, or inflammatory action, 
has extended deep enough to destroy the top of the papilla, but 
not enough to implicate the base, and hence a white hair is the 
result. If we represent the papilla in the follicle diagrammatically 
by the letter A, then that portion above the cross-bar in the letter 
will represent the color-forming part of the papilla; that below, 
the hair- forming portion. 

SUDDEN BRANCHING OF THE HAIR. 

This is the third variety of disorders, and one, next to senile 
grayness, the most frequently seen. A part, or all, of the scalp- 
hair may be the portion blanched ; though the more usual way is 
to have but a portion of the scalp showing the whitening of its 
hirsute covering. This is due, mostly, to some severe nervous 
disturbance, induced by either fright or disease. Some strange 
freaks of nature are observed in the matter of this sudden de- 
coloration of the hair ; for often, in a single night, or in the space 
of a few hours, or even moments, hair, which was formerly of a 
dark color, is changed to a silvery gray. Many of these cases are 
historical facts, as notably that of Marie Antoinette, the Queen 
of Louis XVL, whose magnificent tresses changed to gray in a 
single night (1791), when the royal party was arrested at Varen- 
nes. Another royal instance is that of Mary, Queen of Scots, 
whose auburn hair, through fright and grief, was changed to 
gray in the course of a few days. 

It is also authentically stated that the hair of Sir Thomas Moore 



2^2 MEDICAL AND SURGICAL EMERGENCIES. 

turned gray on the night preceding his execution ; and Dr. Parry 
related the instance of a Sepoy, of the Bengal army, aged twenty- 
four years, who was taken prisoner in 1858, and, while under 
examination, his hair, which was the jet black of the Bengalee, 
turned gray, all over his head, within the space of half an hour. 
Very similar to this last is the case of a Mr. Anderson, a circus 




Fig. 32. Follicle of human hair. 

performer, and friend of one of my patients. His age was thirty- 
nine at the time of the sudden blanching of his hair. During an 
accident to one of the cages he got confined between a large bear, 
that had just broken out, and an elephant which he had made 
angry by giving it a mouthful of tobacco a little while previously. 
He was expecting immediate destruction, and his hair, which was 
quite dark, in the space of a few moments changed to gray, never 
to regain its normal color. 

Turner relates the case of a young man, who had been seized 
by the king's guard, when holding a stolen interview with a lady 
of the Spanish court, and so incarcerated. This was a capital 



MEDICAL AND SURGICAL EMERGENCIES. 233 

offense, and it so terrified the man, when sentence was pronounced 
upon him, that in the same night his hair was turned to gray. The 
occurrence, however, was fortunate, as it saved him his life. 

A German physiologist has observed that several of his 
delirium tremens cases, which he had in the hospital, have been 
affected with a sudden blanching of the hair. He examined the 
hairs under the microscope, and found that air was infiltrated 
throughout their substance. 

Moreau records the case of a man, thirty years of age, losing by 
death a dearly beloved wife ; on the morning following her demise 
his hair, through grief, was found white as snow. 

CAUSES. 

The nervous system is, undoubtedly primarily at fault, in most 
instances. In old age the nerves are among the first of the wheels 
of life to tire out, and break down ; the many instances of blanch- 
ing from fright and sorrow are also so many instances of per- 
verted nervous action ; even in the congenital cases it is the trans- 
mission of nervous (hereditary) impression from the parents to 
their offspring that leads to premature grayness. Among dys- 
peptics, too, gray hair is a common sign; and even here it is un- 
doubtedly a reflex nervous action that induces the decolorization 
of the hair, rather than the non-digestion of the food, per se ; of 
course the dyspepsia is the exciting cause. 

CAPTAIN MARKHAM'S EXPERIENCE;. 

It is also quite well authenticated that cold weather, if pro- 
longed, induces grayness of the beard. Capt. Markham, who once 
commanded a vessel on an exploring expedition to the Arctic 
regions, noted, as a curious fact, that those who were for a long 
period absent from their ship had their hair on their faces bleached 
nearly white. The loss of color was gradual, and, although 
noticed, was never alluded to, each one imagining that his 
companion's hair was turning gray from the effects of hardship 
and anxiety. It was only after their return to the ship that those 
possessing beards and moustaches discovered the change of hue 



234 MEDICAL AND SURGICAL EMERGENCIES. 

in their own hair. And yet the color gradually returned in about 
three or four weeks, after being less exposed to the inclement 
weather. 

Somewhat akin to this is the fact that human hair also grows 
faster in summer than in winter ; also faster by day than by night. 
All these conditions, I think, are clearly explained by the per- 
verted nervous action induced by the cold and absence of the 
usual amount of daylight. The skin is shrunken by the action of 
the cold, and hence, from this, as a mechanical cause, less blood 
is brought to the scalp, less nutriment is supplied to the papillae, 
and so grayness or blanching results. 

The graying of the hair, as an effect of prolonged financial and 
business worry, may be explained in a similar way. Numerous 
instances are on record of the speedily turning gray of the hair 
after business reverses, the same as after grief following the loss 
of friends. Wearing of closely-fitting and illy-ventilated hats, 
especially in the house, or office, is another predisposing cause for 
early grayness. 

Heredity also has much to do as a predisposing cause, though it 
is not so much the white hair factor that is handed down, as it is 
the perverted nervous influences, vitiated constitutions, scrofula, 
and the like, that are transmitted, and which speedily induce 
secondarily, early or premature grayness, or even albinism. 

CONDITIONS WHICH INFLUENCE THE TURNING OF THE HAIR. 

Neuralgia and nerve injuries are frequently followed by a 
turning gray of the hair upon the parts supplied by the diseased 
nerve. I have several ladies under my professional care whose 
neuralgic headaches (confined to the summit of the head) last- 
ing, usually, two or three days at a time, are followed by a marked 
grayness of the scalp over the painful region, though the normal 
color returns after a few days. Dr. Anistie is himself a victim to 
the blanching of the hair upon the right side of the head, owing 
to persistent attacks of supraorbital neuralgia and migraine. 
There is no falling out of the hair, and in a few days, following 
the attack, the normal color is nearly or quite restored. Dr. Paget, 
in his "Surgical Pathology/' relates the case of a lady, subject to 



MEDICAL AND SURGICAL EMERGENCIES. 235 

nervous headaches, who, on the morning following an attack, 
finds her hair, in spots, as white as if powdered with starch ; in a 
few days the normal color returns again. 

TREATMENT. 

In a general way this is referable to two plans — preventative and 
curative. The blanching of hair from fright, the condition known 
as albinismus, and the progressive whitening from age would 
come directly under the first division, as curative agents are rarely 
of avail. The portion of the article dealing with the hygiene of 
the hair can be referred to as a matter of general preventatory 
treatment; to this should be added the inferences that may be 
drawn, from reading the many instances cited, of what should 
be avoided, so far as possible. 

As to curative measures, a stimulating wash, such as : 

Tr. cantharidis (tr. Spanish fly), 1 ounce. 
Aceti destil. (distilled vinegar), 1Y2 ounces. 
Glycerini (glycerine), i 1 /^ ounces. 
Spr. rosmarini (spirits rosemary), 1V2 ounces. 
Aquae rosae (rose water), enough to make 8 ounces. 
M. S. Lotion, to be well rubbed into the scalp, night and 
morning, will be good to apply. 

Frictions of the scalp, with a bristle brush, night and morning, 
bathing the head with cold water, and if the scalp be unduly dry 
and harsh, a dressing, like the following, will prove of service : 

Olei cocois (cocoanut oil), 2 ounces. 
Tr. nucis vomicae, 3 drachms. 
Spr. myrciae (bay rum), 1 ounce. 
Ol. bergami (oil bergamont), 20 drops. 

As, in most cases, the nervous system is exhausted, remedies 
addressed thereto are of value. Nux vomica and phosphorus, 
combined with iron or arsenic, will be indicated. Cod liver oil 
is also an excellent adjuvant. There is a pill already prepared, 
in coated form, that is composed of phosphorus, 1-100 grain; 



236 MEDICAL AND SURGICAL EMERGENCIES. 

strychnia, 1-60 grain; carbonate of iron, one grain, that will prove 
as valuable as any extemporaneous formula. The compound 
phosphorus and quinine pill will also prove of value ; this is com- 
posed of phosphorus, 1-50 grain; reduced iron, one grain; strych- 
nia, 1-60 grain; quinine, 1-2 grain. Either of these pills can be 
given in increasing doses as occasion may demand. Of arsenic^ 
the best form for administration is Fowler's solution, the follow- 
ing making a very eligible preparation: 

Lq. potassii arsenitis (Eowler's solution), 1 drachm. 
Tr. ferri chloridi (muriate tr. of iron), 2 drachms. 
Tr. cinchonae comp., 2 ounces. 

Tr. cardamomi comp. (comp. tr. cardamom), enough to make 
4 ounces. 

M. S. Teaspoonful four times a day. 

If neuralgia is a prominent symptom, this must also be met by 
remedies calculated to overcome the cause; if this be found to be 
dependent upon carious teeth, a dentist should be consulted, and 
the offending members withdrawn ; if upon uterine derangements, 
which is one of the most common causes for early graying of the 
hair in the female, these should receive their proper local and con- 
stitutional treatment; if upon some vicious cicatrix, a surgeon's 
services should be secured, and the irritation from the contracted 
cicatrix relieved. 

Sulphur, administered internally, is thought by some to prove 
of benefit in supplying one of the elements for hair-growth to the 
waning papillae. The yolk of egg, which contains sulphur and 
also iron, applied locally, is also of service ; besides this it is olea- 
ginous, and so supplies this element to a harsh-feeling scalp. An 
iron solution, applied to the hair, will also prove of service, as for 
instance, the following: 

Eerri citratis (citrate of iron), 2 drachms. 
Tr. nucis vomicae, 2 drachms. 
Ol. cocois (cocoanut oil), 1^ ounces. 
Spr. myrciae (bay rum), i\ ounces 

Gray hair, when the filaments are scattered, should be removed 
by the use of hair-dressing tweezers ; as a rule these hairs so 



MEDICAL AND SURGICAL EMERGENCIES. 237 

treated do not return. If the hair is split at the ends, or inordi- 
nately long, it should be clipped back, and so save the drain upon 
the other parts of the scalp as much as possible. 

But in spite of all treatment hair will turn gray when "old age" 
comes on. 

The author is indebted for much valuable information in the 
preceding and following pages on this subject to the following 
authorities: Buckley, Neuman, PifTard, Fox, Leonard, Kaposi, 
and Hebra. 

COMMON BALDNESS. 

This is the form of hair-loss usually seen in young adults, or 
those just reaching middle age; if in the aged, it may occur in 
those whose hair has not previously turned gray. 

As a rule, the light-haired individuals, from the fact that their 
hairs are finer, and hence more numerous to the square inch of 
the surface, are more prone to the loss of their head-covering than 
dark-haired persons. 

The hair usually begins to come on the combing or brushing of 
it; finally, it will be found on the clothing in quite free quan- 
tities, showing that there is a pretty free involvement of the fol- 
licles of the scalp. It is usually seen in our busy, young business 
men, or in an overtaxed mother, or in a young lady of delicate 
constitution. The reason that ladies are not more generally sub- 
ject to this annoyance is, undoubtedly, owing to the physiological 
fact that their bodies are less freely supplied with hair, and hence 
there is more hair-forming material furnished the scalp than in 
men. Another reason is that they are less subject to business 
worry, and do not heat their heads up continually with hats devoid 
of ventilation; the air gets more freely about the scalp and roots 
of a woman's hair than man's, from the fact that they less fre- 
quently cover their heads. 

As a rule, a bald-headed father transmits his peculiarity only 
to his male offspring. It is also a noteworthy fact, too, that the 
tendency to baldness develops earlier in the life of each succeeding 
generation than the one preceding; thus, if the father was bald at 
thirty-six, the son will be pretty sure to be so at thirty-four, and 
;so on. 



238 MEDICAL AND SURGICAL EMERGENCIES. 

CAUSES. 

These are multitudinous. Sometimes it may be owing to abuse 
in dressing the hair, as crimping it too tightly, burning it with 
curling irons, or the use of irritatng coloring matters, and the like ; 
or it may be due to the "old age" of the hair itself; for hair, as 
well as man, has its time of ripening, age, and death. When it 
becomes fully developed, and its life matured, it becomes con- 
tracted just above the bulb, and falls out ; the life germ, of course, 
remaining to fill the empty follicle with new hair at no very 
distant time. Among the more usual exciting causes can be men- 
tioned disease, enervating habits, mental worry, and loss of normal 
nerve nutrition. The worry of an accountant over his books, the 
merchant over his sales, the lawyer over his cases, the physician 
over his practice, the minister over his charge, all these are promi- 
nent factors in the cause of baldness. The reason is that there 
is not sufficient blood brought to the papilla of the hair-shaft, and 
hence the cell-formation, at the root of the hair, is not rapid 
enough to keep the hair follicle properly distended, so as it can 
perform its proper office of moulding the cells to the formation 
of a proper shaft; hence, at this interval, whether marked by ill- 
health or not, the follicle, through its circulary compressing fibres, 
strangles, or cuts in two, the mass of soft hair-cells, just forming 
into a hair-shaft, and the hair falls out as the result. Often there 
is a little bulb seen at the end of the hair, after it has been sub- 
jected to this choking off process ; this has led some observers to 
say that the root has been thrown out; but this is not the case; 
were it so, then there would be no regrowth of the hair, for when 
the root is once destroyed, hair-life can never be regenerated in 
that follicle. 

The loss of hair following fevers and other debilitating diseases 
takes place in much the same manner, and as the result of the 
weakened state of the forming papillae, the regrowth is apt to be 
of different color or shape; after a time, though, when the hair- 
forming organs regain their usual vigor, the normal color is 
usually wont to return. 

Loss of hair through head neuralgia, as is common to many of 
our ladies, is in the same manner. The proper amount of blood is 
not carried to the new cell-forming papilla, it is also vitiated, and 



MEDICAL AND SURGICAL EMERGENCIES. 239 

the nervous excitement, indicated by pain, causes a reflex con- 
traction of the skin about the follicle, and hence the hair is girdled, 
and so falls out. Doubtless the change in color of the hair, through 
excitement, occurs from the same cause. When the excitement is 
calmed a normal blood circulation and nerve action ensues, hence 
the normal color-cells are secreted in their normal abundance, and, 
as a result, the color is restored. I believe the physiological action 
of the two to be similar, differing only in degree; if continued 
long enough, loss of hair would be the result. I have a patient 
under care now, a young married lady, with uterine disease, where 
the hair becomes very gray on the second morning following an 
attack of this head pain — at the top of the head — but in a day or 
two returns to its normal color (brown). If the pain were con- 
tinued long enough I doubt not that the final result would be local 
baldness, through the malnutrition of the follicles. In proof of 
this I cite the following case : 

Nayler gives an instance of a lady, in middle age, suffering from 
headaches, radiating from the temple to the crown, who had a 
total loss of hair over the seat of pain. In six months, after the 
neuralgia was cured, the hair grew rapidly again, though it was 
white in color; this gradually changed, however, to its normal 
hue. 

Syphilis is also a well known cause for the loss of hair, though 
it is not the common cause, as is often asserted. For centuries the 
loss of hair following this disease was not noticed ; thus, Brassa 
(1533) writes that "venereal symptoms have been observed which 
render it doubtful whether the disease is declining, or whether it 
has changed its character. The first of these symptoms is the 
falling off of the hair. One cannot help laughing at seeing men 
without beards, eyebrows or eyeleashed." 

TREATMENT. 

If you are an accountant take fewer hours at your desk, more 
in the open air ; the hair makes a good barometer (in truth, aneroid 
barometers are made from hair) for the state, of health, as well as 
of the atmosphere, and when you thus find it being progressively 
shed, look carefully to your occupation, to see if that is not the 
cause. If you are indoors a great deal, get in warmer friendship 



240 MEDICAL AND SURGICAL EMERGENCIES. 

with your gun, rod and line, and horse, or even take a relaxation 
trip. Don't wear your hat in the counting room or store; go 
bareheaded as much as you can, and have your hat a ventilated 
one. If you are using tobacco excessively, put the brakes on there ; 
be temperate in all things, and above all secure a good night's rest ; 
court sleep, 

"Tired nature's sweet restorer, 
That knits up the unraveled sleeve of care." 

There is nothing like good sound sleep to recuperate the nervous 
system, for this is the system that is first out of order when the 
hair begins to fall. Leave your figures in your office ; don't take 
them to bed with you to dream over; or if you are an inventor, 
or writer, don't make your bed room, your study room, or your 
meal time a convenient time for straightening out that kink, plot, 
or ledger discrepancy. Take three full hours every day to eat your 
supper, breakfast and dinner in, and a mile walk after each, if 
possible. All this done, and if yet you feel tired and exhausted, 
go to some physician who will look your case over for you, and see 
what organs are still at fault. The bowels should be kept regular, 
.and for this purpose there is no remedy less harmless, or more to 
be depended upon, than one of the Rhamni, thus: 

Fl. ext. rhamni Purshianae (cascara sagrada), vel (or) 
Fl. ext. rhamni frangulae (buckthorn bark), 2 ounces. 
Syrupi sim. (simple syrup). 

Aq. cinnamomi (cinnamon water), aa. (of each) I ounce. 
M. S. Dessertspoonful before breakfast, or three times a day 
if necessary. 

Instead of this, oil, epsom salts, rhubarb, seltzer or Hunyadi 
water might be employed. As tonics, Peruvian bark and iron are 
among the best. The following is a very common prescription 
with me: 

Tr. cinchonae comp. (compound tr. cinchona), 2 ounces. 

Ferri citratis (citrate of iron), 3 drachms. 

Tr. nucis vomicae (tr. nux vomica ),i J drachms. 

Vini Xerici (sherry wine), 3 ounces. 

M. S. Teaspoonful one-half hour after meals. 



MEDICAL AND SURGICAL EMERGENCIES. 241 

Besides, the head should be kept in as cleanly and hygienic a 
condition as possible. p- 

Among the many local applications that could be given, the 
following I have found to prove of great value: 

Tr. cantharidis (tr. Spanish fly), 2 drachms. 
Tr. nucis vomicae (tr. nux vomica), \ ounce. 
Tr. capsici (tr. capsicum), 1 drachm. 
Ol. ricini (castor oil), \\ ounces. 
Aq. cologniensis (cologne water), 2 ounces. 
M. S. Liniment. To be applied with a piece of sponge, night 
and morning after brushing the hair. 

If the oil is an objectionable feature, as it is with some, bay 
rum (spr. myrciae) may be substituted. Cocoa oil and cocoaleine 
also make good substitutes. 

A preparation of arsenic, given internally, is also of great bene- 
fit in most of these cases. It should not, however, be prescribed 
indiscriminately. The following makes a very eligible mixture, 
•combining all other tonics with it: 

Liq. potassii arsenitis (Fowler's solution), \\ drachms. 

Ferri citratis (citrate of iron), 2 drachms. 

Tr. nucis vomicae (tr. nux vomica), 1 drachm. 

Tr. cinchonae comp., q. s. ad 4 ounces (enough to make 4 oz.). 

Prof. Erasmus Wilson recommends the following: 

Lq. ammoniae (spr. hartshorn). 

Chloroformi. 

Ol. amygdalae dulcis (sweet almond oil), aa. (of each) I ounce. 

Spr. rosmarini (spr. rosemary), 5 ounces. 

This is to be rubbed into the roots of the hair, after brushing the 
scalp. Undoubtedly it is too strong for most scalps, and it will 
need to be diluted about one-half before applying. Cologne water, 
or rose water, may be used for this purpose. 

Dr. Pincus suggests the following treatment in the first stage of 

premature baldness (This stage is recognized by a daily loss of 

under fifty hairs, by diminished sensibility to pressure, and, after 

a time, by commencing hardness and immobility of the scalp) : a 

16 



242 MEDICAL AND SURGICAL EMERGENCIES. 

solution of caustic potash, one part to five hundred of water, or 
fifteen grains of the bicarbonate of potash to an ounce of water. 
Two or three drachms of this solution are to be rubbed into the 
scalp from three to five minutes daily. After a time this may be 
done every other day, and then only once a week. If this is con- 
tinued for a year or more, he avers, the baldness is arrested, and, 
in some cases, the lost hair is fully restored. 
The following is also a useful lotion : 

Liq. ammonii acetatis (spr. Minderus), 2 ounces. 
Ammonii carb. (carbonate of ammonia), -| drachm. 
Glycerini (glycerine), -J ounce. 
Ol. ricini (castor oil), -J ounce. 
Spr. myrciae (bay rum), 5 ounces. 

M. S. Lotion. Apply to roots of the hair, night and morning, 
with sponge, after brushing thoroughly. 

• 

The following is also a very good lotion : 

Tr. iodinii comp. (compound tr. iodine), 2 drachms. 

Tr. cantharidis (tr. Spanish fly), 2 drachms. 

Spir. myrciae (bay rum), 1^ ounces. 

Aq. cologniensis (cologne water), 2 ounces. 

M. S. Apply to the bald portion of the scalp twice a day. 

Pomades are sometimes ordered, but I do not like these, as a 
rule, as they mat the hair together more than lotions, and make it 
too greasy for the comfort of the user. Still, the following, when 
these features are not objectionable, will be very useful : 

Tr. iodinii (tr. iodine), 2 drachms. 

Pulv. cantharidis (powdered Spanish fly), \ drachm. 

Acidi tannici (tannic acid), 1 drachm. 

Ol. bergami (oil bergamont), 20 drops. 

Vaselini (vaseline), 2 ounces. 

M. S. Apply to the head night and morning. 

What has been said regarding the medical treatment of bald- 
ness in men, is equally applicable to the cases occurring in the 
opposite sex. Ladies, however, must forego the use of the crimp- 



MEDICAL AND SURGICAL EMERGENCIES. 243 

ing pins and curling iron, as well as the use of bleaching or color- 
ing agents. The hair should be done Up loosely or suffered to hang 
down undressed. 

As the Manillians have the longest, blackest and most glossy 
hair of any nationality, and do not bind or curl it tightly to the 
head, but allow it to fall back behind, in its own natural looseness, 
it follows, that if our ladies would wish to preserve their hair 
as long as possible, that they should imitate the Manillians in this 
custom. The tonic systematic treatment is just as necessary in 
their cases as in the cases of men, and the preceding formulae are 
as good as any. Out-door exercise should be regularly taken ; if 
family cares are crowding too closely upon them, a trip to the 
seaside will be beneficial. Worrying or fretting over any matter 
only makes the fall of the hair the worse, hence all this should be 
avoided as much as possible. Good, healthy, plain food only 
should be taken ; eating of sweetmeats, late hours at the ball-room, 
and kindred enervating practices, should be abandoned, and a stay 
of eight hours in bed be taken each night, till the system becomes 
recuperated. In cleansing the head and hair, as it should be done 
every week or ten days, in summer time, less often in winter, 
there is nothing better than the yolk of an egg, beaten up in a 
little water, and rubbed thoroughly over the scalp and through the 
hair on a bit of sponge, and then the whole rinsed with warm 
water, and dried by pressing between cotton or linen towels. The 
ends of the hairs, if they split, should be trimmed off an inch or so 
and thus kept back until this tendency is overcome. In brushing 
the hair, only a soft brush should be used ; but this used carefully 
will be found to bring a warm glow to the scalp, and thus ma- 
terially aid recovery, for it is the aim of the whole treatment for 
baldness to quicken the sluggish circulation in the scalp. 

Electricity applied with proper care, to the scalp by means of 
a wet sponge, one of the poles of the battery being placed at the 
nape of the neck, will also be found of service in stimulating the 
nervous action, and thus increase the amount of blood sent to 
each hair follicle and its papilla. 

DYEING THE HAIR. 

I do not really recommend the use of these various dyes, even 
in the many cases of early blanching of the hair ; as regards my- 



244 MEDICAL AND SURGICAL EMERGENCIES. 

self, the sight of gray hair is not unpleasant. I rather like gray 
hairs ; they are, in the aged, the emblems of wisdom ; they remind 
us of hearts that have been steadfast amid all external changes and 
friendships, and which time and circumstances have not changed 
or weakened. 

Almost all the so-called hair-dyes, which should more properly 
be called paints, depend upon the action of minerals for their 
blackening process. All of the patent right ones, with hardly an 
exception, contain lead in some form. A few varieties are made 
up of lead alone; these are absolutely harmless; those containing 
sulphur, or nitrate of silver, can be used so excessively as to be 
productive of hurt; yet, I think their dangerousness has been 
overrated, when they have been used in moderate quantities. 

The following iron preparation will be found valuable to darken 
the hair, and it also has the advantage of being non-poisonous : 

Sulphate of iron, i drachm. 

Alcohol, i ounce. 

Oil rosemary, 12 drops. 

Pure water, J pint. 

M. and apply frequently to the hair and scalp. 

This preparation has another advantage, that of being of use 
when dandruff is present upon the scalp. By leaving out the oil 
of rosemary and alcohol, and putting in equal parts of water and 
cologne water, a very eligible preparation is formed. A wash 
very similar to this is a great favorite among the fashionable 
Parisians. 

The following is said to give a good and natural-looking dye, 
free from the caustic action of silver salts and the poisonous 
effects of lead compounds. Two preparations are needed : 

No. 1. 

Citrate of bismuth, 1 ounce. 

Rose water, 2 ounces. 

Distilled water, 2 ounces. 

Alcohol, 5 drachms. 

Ammonia, q. s. 

M. S. Apply in the morning thoroughly to the hair. 



MEDICAL AND SURGICAL EMERGENCIES. 245 

No. 2. 

Hyposulphite of soda, 12 drachms. 

Distilled water, 4 ounces. 

M. S. Apply in the evening thoroughly to the hair. 

Instead of waiting so long as this, the preparations could be 
applied, if necessary, an hour or so apart ; the morning and even- 
ing alternate application is usually found the best. This dye 
is based on the chemical action of the reduction of the hyposul- 
phate of soda by bringing it in contact with the citrate of bismuth, 
the result being a formation of the sulphate of bismuth. As red 
and blond hair contains sulphur in excess of the other colors, we 
know why such hair retains its color better than hair of other 
hue. 

Nitrate of silver is probably as generally used as any of the 
salts of the metals (unless it be the acetate of lead) for produc- 
ing a change in the coloring of the hair. Usually the strength of 
the solution is from five to ten grains of the silver to the ounce 
of water, as in the following: 

Nitrate of silver, 10 to 60 grains. 

Distilled water, 2 ounces. 

M. S. Apply to the hair, wetting it thoroughly. Then let dry 
slowly by evaporating in the sunshine, or heated room exposed to 
the light. 

If time is of importance, the darkening of the silver solution 
can be hastened by applying the following solution a few mo- 
ments after the nitrate of silver is used: 

Potassii sulphureti, 1 to 6 scruples. 
Distilled water, 2 ounces. 

This will make an almost instantaneous change to a black hue, 
if the silver solution has been first used. Where there are only 
streaks of gray here and there upon the scalp, a single application 
will be all that is required, till the hair is grown out quite a dis- 
tance, so that the portion nearest the follicles will need color-dres- 
sing again. The objection to this dye is that it stains the scalp and 



246 MEDICAL AND SURGICAL EMERGENCIES. 

hands as thoroughly as it does the hair. To avoid this, great care 
should be used to protect the scalp, and gloves should be worn 
upon the hands during the application. A brush will probably be 
found the most convenient applicator. 

The ordinary lead preparations are made up of the sugar of 
lead, ten to twenty grains to the ounce of water, as follows : 

Sugar of lead, 40 grains. 

Distilled water, 2 ounces. 

Apply this to the hair thoroughly, and when about dry apply a 
solution of the sulphide of ammonium, about one-fourth the 
strength of the British Pharmacopoeia solution. 

The objection to the last compound is its very unpleasant odor. 
It gives though, an excellent brown or black color to the hair, 
according to the strength of the solutions employed, and does not 
stain the scalp. 

The mercuric dyes are best represented by the following: 

Corrosive sublimate, 12 grains. 

Rose water, four ounces. 

M. S. A poison. To be used with great caution and externally. 

If there are any abrasions on the scalp this solution should not 
be employed, as enough of it might be absorbed to produce dele- 
terious results. It is best applied to the hair by means of a brush 
dipped in the solution, and then thoroughly brushed through and 
over the hair. When it has become dry the following should then 
be employed : 

Sodii hyposulphate, 1 ounce. 

Water, 2 ounces. 

M. S. Apply externally. 

The same brush should not be used for making both applica- 
tions. The solutions can be applied, one at night, and the other 
in the morning, for a few days, then once or twice a week, until 
the desired result is obtained. This is quite a slow-acting dye. 

In the use of any of the above dyes, or indeed any of the fol- 
lowing, the hair should be thoroughly cleansed from all oleaginous 



MEDICAL AND SURGICAL EMERGENCIES. 247 

material ; this may be done by washing in toilet-soap suds, or by 
the free use of bay rum and cologne water, and then drying. 
After the dye is once "set/' oil, cocoa-nut is the best, should be 
applied as a dressing to help bring out the color and the gloss; 
also to prevent too much drying of the hair. 

Brown hair dye. Sometimes plumbic acetate and sulphur are 
combined together in one and the same solution, of the strength 
of the following: 

Plumbi acetatis (acetate of lead), \ drachm. 

Sulphur sublimati (flowers of sulphur), 1 drachm. 

Aquae (water), 4 ounces. 

M. S. Shake well and apply night and morning for a week or 
so, then decrease the frequency of the application, gradually, to 
once a week, or once in two weeks. 

This is a slow dye, yet one that answers fairly when there is 
not much grayness to the hair. It also is a very mild preparation. 
The deposit left upon the skin can be easily brushed off when it 
becomes dry. Like all of the head dyes it acts best upon hair of 
a reddish tinge, though gray hair is turned to a brownish color 
by it. Its effect upon light hair is to give more of a dark brown 
tint to it. 

The following also makes a very good brown, and the tint can 
be darkened, as the fancy may desire, by a continued application 
of the two preparations : 

Sulphate of copper, 16 grains. 
Distilled water, 4 ounces. 

M. Apply thoroughly to the hair, and when dry or nearly dry 
use the following : 

Potassi ferrocyanidi, 16 grains. 

Distilled water. 4 ounces. 

M. Apply by means of a sponge or brush. 

This last solution is poisonous, if swallowed in any quantity, 
and hence should be kept out of the reach of children ; indeed so 
should all dyes. It does not stain the skin, and simulates, very 



248 MEDICAL AND SURGICAL EMERGENCIES. 

closely, the normal brown coloring given by nature, when applied 
to gray hair. 

The following will also give a very good dark brown, and even 
black, if applied frequently enough : 

Ammonia-nitrate of silver, I drachm. 

Distilled water, 4 ounces. 

M. 

Care should be had not to bring this into contact with the 
skin any more than possible, as it will stain it. Its application 
should be followed, when the hair becomes dry, with the follow- 
ing: 

Pyrogallic acid, 2 drachms. 

Distilled water, 4 ounces. 

M. Apply by means of sponge or brush. 

The permanganate of potash may be used to give a light brown 
color to the hair ; it should be used in the strength of from ten to 
forty grains to the ounce of distilled water. It makes but little 
discoloration of the skin, and is perfectly harmless. The brown 
color can be deepened, and even changed to a black, by using, 
alternately with the permanganate solution, the solution of pyro- 
gallic acid just mentioned. 

To dye the hair red. This is usually on the plan of bleaching 
a darker colored hair down to this color ; though sometimes a true 
coloring principle is desired, as when gray, or light blonde hair is 
sought to be darkened to this color. The least harmful of all the 
dyes is the Persian Henna before described (see under the head- 
ing of black hair dyes). 

Auburn hair is hair having a tinge of red, and this stage is 
sometimes reached in bleaching dark brown hair down to that of 
yellow, or blonde hue. 

A strong infusion of saffron, to which has been added some 
carbonate of soda, if followed by an application of lemon juice or 
vinegar, will give a reddish yellow hue to dark-colored hair. 

Bronzonette, whatever that may be, will, it is said, with the 
aid of spirits of wine, give a crimson coloring to the hair. Thirty 



MEDICAL AND SURGICAL EMERGENCIES. 249 

drops of the bronzonette to a couple of drachms of alcohol is the 
usual amount taken. As the color begins to pale, a new applica- 
tion of the alcohol will revive it considerably. 

Some of the salts of antimony are also made use of, as the ordi- 
nary tartar emetic, in hair dyeing. Thus : 

Tartar emetic, 1 drachm. 

Pure water, 2 ounces. 

Tartaric acid, 5 grains. 

M. Apply with sponge to the hair. 

Care must be taken that the scalp is not much wetted with this 
solution, lest enough become absorbed to vomit the individual. 
Its application is to be followed with a slution of ammonic sul- 
phide, one part to four parts water. This works the best upon 
light-brown hair. 

Yellow or ''blonde" dyes. The Roman ladies used a very im- 
pure kind of soap, made from ashes and goat's fat mixed, 
for blanching their locks. A town in Germany — for the Germans 
are by nature blondes, or a light-haired race — called Matium, 
used to furnish this substance in balls to the Roman cosmetic- 
vendor, and hence the common name for the article was "mattic 
balls." Akin to this is the "potash treatment" so much in vogue 
with us today, when maidens will persist in washing their dark- 
colored tresses with strong soap-suds, or a weak solution of caus- 
tic potash, and then expose themselves to the sun. The blanching 
of the hair is obtained by this method, and is perhaps the least 
harmful of any, though more slow in its action than some. How- 
ever, it is some form of chlorine or sulphurous acid, or nitric acid 
that is now most made use of for bleaching the hair. These 
agents work more rapidly than the alkalies (potash or soda), and 
are not so apt to injure the texture of the hair; they are used by 
our wig-makers to blanch the locks they are making up for sale. 

A weak solution of the nitro-muriatic acid, as it combines both 
nitrogen and chlorine, is the better agent to employ. The strength 
of this will need to vary as the occasion may require ; but starting 
with the weaker solution, whose strength can be increased after a 
time, frequently applied, will be the safer way ; you must remem- 



250 MEDICAL AND SURGICAL EMERGENCIES. 

ber that in one sense you are killing the hair, that is its color, and 
hence caution is needed. A solution, somewhat as follows, would 
be well enough to start with : 

Acidi nitro-muriatici diluti, 4 drachms. 
Aquae, 4 ounces. 

M. S. Apply by means of a sponge, and dry in sunshine, or by 
the aid of hot irons. It will not injure the skin. 

The officinal aqua chlorinii, or chlorine water, might also be 
used in the same manner as the lotion just given to fulfill the 
same purposes. 

As harmless, though perhaps not quite so effectual as some of 
the other dyes spoken of, is the following wash : After washing 
the hair thoroughly with a solution of alum, the strength not im- 
portant, bathe it with a tea made of the annotta (the ordinary 
cheese-coloring produce), in which a little common baking soda 
has been dissolved. This application has to be made a number 
of times before much change is noted in the color, as it is very 
mild. If each application, when dry, is followed by a washing 
with vinegar, or water soured with lemon juice, the color will be 
deepened somewhat. It is only applicable for very light hair, as 
it contains no "bleaching'' agent. 

Stannic chloride, with a mordant of ammonic sulphide, will also 
turn the hair a yellow color, through the bleaching agency of the 
chlorine and sulphurous acid that is present in the two lotions. 
So also will the application of a solution of plumbic acetate, fol- 
lowed up with a mordant of potassic chromate. 

All of these bleaching agents, if used excessively, are apt to 
leave the hair crisp and dry, or even to extend their ravages far- 
ther and so destroy the existing growth entirely. 



MISCELLANEOUS. 

Treatment of Ringworm — Treatment of Sweating of the 
Feet — When Spectacles Should be Used — Some Uses of 
Electricity in the Treatment of Diseases — Signs of 
Death — Neurasthenia — Neuralgia — Tic Douloureux — 
Hypochondria — Hysteria — Insomnia — Skin Diseases — 
Bronchitis — Pneumonia — Hay Fever — Green Sickness or 
Chlorosis — Jaundice — Appendicitis — White Swelling — 
Hemorrhoids or Piles — Aphthae — Thrush — Canker Sore 
Mouth — Burns and Scalds — Enlarged Tonsils — Broken 
Breasts — Toe-Nail, Ingrowing — Urine, Incontinence of, 
Retention of — Preparation of Bottled Milk — Vegeta- 
rianism — The Eruptive Fevers — Period of Incubation. 

the treatment of ringworm. 

Dr. Saerlis recommends oil of turpentine for the cure of ring- 
worm of the scalp. The hair should be closely cut over the 
affected part, and for a short distance around, and then turpentine 
is to be liberally applied, and rubbed in well with the ringer. This 
is allowed to remain for about five minutes, and is then washed 
off with carbolic soap, and afterward with hot water, and the 
patch is then painted with dilute tincture of iodine, or with a two- 
per-cent. solution of iodine in turpentine. The application is to be 
made once or twice a day, and is not painful, though it causes a 
slight smarting. The writer asserts that he has cured, in ten 
days, by this method, cases of ringworm that have resisted all 
other modes of treatment. 

TREATMENT OF SWEATING OF THE FEET. 

Dr. Hebert gives the details of a method first suggested by Dr. 
Legoux, which he has found most efficacious for the relief of 

251 



252 MEDICAL AND SURGICAL EMERGENCIES. 

sweating of the feet. For three days the feet are bathed, for half 
an hour at a time, morning and evening, in tar-water. At the end 
of the third day the foot-baths are omitted, and the soles of the 
feet are painted once a day with perchloride of iron. After four 
days more the epidermis of the soles is found to be dry and hard. 
Dr. Hebert succeeded in obtaining a complete cure by this simple 
means. - 

WHEN SPECTACLES SHOULD BE USED. 

When we are compelled to remove small objects a considerable 
distance from the eye. When we find the light insufficient. When 
the object appears blurred, cloudy, or has a mist before it. When 
the letters of a book run together or appear double or treble. When 
the eyes become fatigued after reading or other exercise. These 
rules answer in many cases, but not always. Never choose a pair 
of spectacles when the eye is fatigued. Wait an hour or two, after 
you can be better suited. The tired eye needs rest, not glasses, and 
if they are purchased when the eye is excited or tired, errors are 
certain to occur in selecting the proper glasses. Wait patiently 
for an hour or two, or better still, three. 

SOME USES OF ELECTRICITY IN THE TREATMENT OF DISEASES. 

During the last decade, the uses to which electricity has been 
applied have been numerous, and while there is a difference of 
opinion as to the beneficial results from its use, the best physicians 
and surgeons of this country, as well as those across the water, are 
of the opinion that in a select number of cases the use of electricity 
supersedes all other methods of treatment. 

The efforts of some enthusiasts to find in electricity a panacea 
for all human ailments is, of course, absurd, and has had the effect 
of creating a certain amount of prejudice against its proper use. 
There are three forms of electricity which have been utilized, viz. : 
The estatic or frictional form, galvanic, and faradic. 

It is not within the province of this article to deal with the me- 
chanical side of electricity, nor to go into the general therapeutic 
action of electricity upon the different forms of disease. In order 
for one to apply this remedy intelligently, it is necessary to be 



MEDICAL AND SURGICAL EMERGENCIES. 253 

familiar with the different forms, as well as the action of elec- 
tricity upon both diseased and healthy tissues. 

Probably the chief reason why it has not enjoyed a more exten- 
sive use in the past is on account of the incomplete construction of 
electrical equipment for medical uses, also the insufficient knowl- 
edge possessed by the regular physician as to its use. 

It has been used by the charlatan, or quack, in a grand-stand 
method, and of course its use was necessarily limited, and did not 
receive the sanction of the medical profession until the last few 
years. 

An eminent author and a practitioner in medicine for twenty- 
five years, has made a special study of electricity based upon 
physiological principles in the treatment of diseases, both in pub- 
lic institutions and in private practice. In connection with it, he 
has also found water, gymnastics, massage, manual and mechan- 
ical exercise, heat, sun-light, diet and other agents, to be of great 
utility in addition to medicines in accomplishing results. There 
are some forms of diseases in which one or more of the above will 
t>e found beneficial, and others in which a combination will achieve 
results. 

A chronic invalid who has gone the rounds of a physician with- 
out any lasting benefit, is often willing to grasp at a straw, and 
in not a few hopeless cases, the above various remedies, mechan- 
ical and otherwise, intelligently applied, have relieved many a 
chronic invalid from a life of misery and wretchedness. 

The single application of one remedy to some diseases is like 
trying to lift a large building with one jack-screw, while, in 
reality, a dozen or more is absolutely necessary to accomplish the 
result. 

The application of electricity to diseases is so numerous and 
technical in its detail that the reader had better consult a physician 
who has given the subject more or less attention. It is in order 
that he may appreciate the uses of electricity that the above re- 
marks are made in this work. There are a few diseases in which 
its application has been found very beneficial, for instance, for the 
relief of pain in the neuralgic joint. A mild galvanic current pre- 
ceded by hot applications are among the most useful measures for 
this affection. 



254 MEDICAL AND SURGICAL EMERGENCIES. 

CERTAIN FORMS OF CHRONIC CONGESTION OF THE PELVIC ORGANS. 

The good effects obtained from local electrical applications has 
been experienced by many suffering individuals. The applications 
of electricity to paralyzed and shrunken muscles, together with the 
application of cold water and friction has had a marked effect in 
increase in the irritability and circulation and nerve force in that 
particular part. 

For the relief of pain in general the application of electricity 
renders most valuable service, together with the associations of 
heat. When the pain is neuralgic in character, a mild soothing 
current, combined with hot fomentations continued from fifteen to 
twenty minutes often causes powerful and gratifying results. 

The application for the relief of headache due to congestion of 
the brain, in which the cold applications do not produce favorable 
results, applications of the galvanic form may be made to the head 
and back of neck with very excellent results. 

When a tonic effect is desired, as in cases of anaemia, melan- 
cholia, and many other conditions in which there is a deficiency 
in the circulation of the blood to the extremities, the faradic cur- 
rent is generally found preferable. 

The use of electricity in the treatment of diseases in which the 
ends of the nerves are affected, has the most extended use, as for 
instance, paralysis of the muscles which move the eye, also those 
of the face, and those of the shoulder and arm, neuralgia of the 
chest, which includes the muscles of respiration; the use of the 
electric current in these forms very often causes immediate relief. 

The sciatic nerve, the principle nerve of the lower extremity, is 
probably most often affected of any of the larger nerves of the 
body, and disorder here is both painful and difficult to get rid of. 
Cold, wet, and overexertion of the leg are found to be the most 
frequent causes of this form of neuralgia. With the patient lying 
on the back, with the body lying upon it, the other electrode is 
applied along the different points in the course of the nerve, and 
gradually the current is applied with the latter electrode moving 
up and down as the points of pain would indicate, the applications 
being made daily or every other day. There is increase in the 
warmth of the part and a decrease in the pain with relief in not 
a few cases being permanent. 



MEDICAL AND SURGICAL EMERGENCIES. 255 

ELECTRICITY IN DETECTING FEIGNED DISEASES. 

In addition to determining the presence, or absence, of nerve or 
muscle degeneration, and the discrimination between cerebral and 
spinal paralysis and the various types of peripheral palsy, it has 
been found of value in determining the length of time subjects 
have been dead. For instance, it is stated that muscular contrac- 
tions produced by the faradic current cannot exist four hours after 
the subject is dead. Maligners often assume epilepsy and paraly- 
sis ; a strong faradic current to the forehead or tibia, by means of 
a wire brush, applied to one feigning epilepsy, will cause intense 
pain to the false epileptic, but in the true epileptic, no pain will be 
felt. 

Feigned anaesthesias may also be told by the faradic wire brush, 
attached to the negative reophore, the limb will quickly respond 
and show how much actual anaesthesia exists ; it has also been 
found useful in motor paralysis. 

There are some basic principles in the use of the different forms 
of electricity with which it becomes necessary to be more or less 
familiar. In hysterical patients where paralysis exists muscular 
reactions to either faradic or galvanic currents may be increased ; 
in rheumatic paralysis electro-muscular contractility is, as a rule, 
more or less increased, although there are some exceptions. 

In peripheral paralysis both faradic and galvanic reactions are 
altered after ten days has elapsed, the muscular contractility being 
lost early to a greater or less extent. No alterations in the electro- 
contractility of muscles is observed in any of the diseases confined 
to the posterior part of the spinal cord. 

NERVOUS REACTIONS. 

When exaggerated on both sides under a weaker current than in 
health, the probability is that there exists a central lesion ; then 
again suppose a case of localized paralysis is thought to exist and 
the faradic and galvanic reactions of both nerve and its muscles 
are normal and exactly alike on both sides ; we have then reason 
to believe that the existing case is either hysteria, some lesion of 
a higher spinal segment than that from which the nerve arises, or 
a lesion within the brain. 



256 MEDICAL AND SURGICAL EMERGENCIES. 

In unilateral paralysis, the muscles of the paralyzed side 
should be contrasted with those of sound side, and also the corre- 
sponding muscles. When both sides are impaired the standard of 
comparison is the sound patient. 

SIGNS OF DEATH. 

In the absence of a physician it sometimes becomes important 
that others shall be able to determine whether death has taken 
place or not. The occurrence of death can be recognized by the 
following signs: The breathing and pulse cease, the surface be- 
comes pale, the muscles relax, the lower jaw falls a little, the 
"sight" of the eye becomes dull and glazed, the upper lid falls so 
as to partly cover the eyeball, and the whole body gradually cools 
to the temperature of the surrounding air and becomes rigid, 
while later decomposition sets in, and usually shows itself first by 
a green discoloration of the surface of the abdomen. 

But it does not require the detection of all these signs to deter- 
mine that death has taken place. The cessation of breathing and 
of the heart-beat is a safe basis for an opinion. It requires some 
care, however, to decide that there is no breathing or circulation. 
To test the former, a cold piece of polished steel — like a razor 
blade or table knife — can be held under the nose and before the 
mouth. If no moisture condenses upon it, it is safe to say there 
is no breathing. To test the cessation of the heart-beat, it is not 
enough to feel for the pulse at the wrist. The largest blood-vessel 
of the body runs directly down from the heart, along the left side 
of the spinal column, and its strong beating can be plainly felt in 
most people by pressing the finger tips firmly down toward the 
backbone, at the point below the breastbone called the "pit of the 
stomach." In this place the slightest pulsation of the heart can 
be felt if the walls of the abdomen permit the finger to get near 
the backbone, and here examination should be made before de- 
ciding that the heart has ceased to beat. Another test is listening 
over the region of the heart, in front of the left side of the chest. 
An acute ear can always detect the movement of the heart by 
sounds made by its valves, which, when perfect, sound like the 
syllables "ub-dup," "uf-dup," and so on. If careful listenings fail 



MEDICAL AND SURGICAL EMERGENCIES. 257 

to detect the heart sounds, and the cold metal fails to show any 
evidence of breathing, the individual may certainly be said to be 
dead. 

When, in addition to these signs, paleness, muscular relaxation, 
a glazing eye, increasing coldness and rigidity come on, it hardly 
requires the onset of decomposition — the infallible sign — to prove 
foeyond any possibility of doubt, that death has occurred. 

The electrical battery may be used, in doubtful cases. Electric- 
ity distinguishes with absolute certainty between life and death. 
Within two or three hours after the stoppage of the heart, the 
whole of the muscles of the body will have completely lost their 
electric excitability. When stimulated by electricity they no 
longer contract. If, then, when electricity is applied to the mus- 
cles of the face, limbs or trunk, after supposed death, there be no 
contraction, death has occurred. No faint, no trance, no stupor, 
however deep, can prevent the manifestation of electric muscular 
contractility. 

But ordinarily it is very easy to decide between death and life ; 
and the fear of being buried alive, which torments many people, is 
altogether without good foundation. The stories upon which it 
rests are such as an excited imagination might easily invent, and 
natural fear propagate, but they do not bear critical investigation. 
In certain European cities, for many years, the bodies of hundreds 
•of thousands of those supposed to be dead have been placed in 
rooms where ingenious appliances and careful watching have been 
used to detect the slightest evidence of life, and in not a single case 
has a mistake been found to be made. 

NEURASTHENIA. 

Synonyms. Spinal irritation ; nervous prostration ; nervous ex- 
haustion. 

Definition. A debility of the nervous system, causing an in- 
ability or lessened desire to perform or attend to the various duties 
or occupations of the individual. 

Causes. It may result from various chronic diseases; mental 
worry or emotion; overwork, as "whenever the expenditure of 
nerve force is greater than the daily income, physical bankruptcy 
17 



258 MEDICAL AND SURGICAL EMERGENCIES. 

sooner or later results" (Jackson). Neurotic temperament ; sexual 
excesses ; alcohol ; tobacco. 

Symptoms. Nervous debility may affect any organ of the body. 
It is a condition of nerve-tire or exhaustion, and hence the nerv- 
ous energy necessary for functional activity of any particular or- 
gan is wanting, a fair example being seen in cases of nervous dys- 
pepsia. 

One of the earliest manifestations of nervous exhaustion is an 
irritability or weakness of the mental faculties, as shown by ina- 
bility to concentrate the thoughts, and efforts to do so causing 
headache, vertigo, restlessness, fear, a feeling of weariness and 
depression, together with the army of symptoms attendant on 
nervousness. 

There may be occular disturbances, palpitation of the heart, 
coldness of the hands and feet, chilliness, followed by flashes of 
heat, followed in turn by slight sweating. Patients are also 
troubled with wakefulness, or when sleep does come, it is accom- 
panied with unpleasant dreams, and is not refreshing. 

It is of importance to determine between neurasthenia and other 
forms of nervous debility, due to organic diseases of the nervous 
system. These diseases are generally curable except when compli- 
cated with some form of mental derangement. The treatment is 
varied and important. Very often a change of scene is very de- 
sirable. If the patient lives in the country, a trip and visit in the 
city is often beneficial, while, on the other hand, if the patient lives 
in the city, a visit in the country, where the surroundings are 
pleasant, is very often just what is needed. In any event, remedies 
to build up the nervous system are always indicated, together with 
nourishing diet and relief, far as possible, from all mental and 
physical strain. 

NEURALGIA. 

Definition. A disease of the nervous system, manifesting itself 
by severe and sudden pain, of a sharp and darting character, 
mostly one-sided, following the course of some part of the nerve. 

Varieties. There are some five or six varieties, located in as 
many parts of the body. First, of the face ; second, of the head ; 
third, of the neck and shoulders; fourth, of the back and ribs; 



MEDICAL AND SURGICAL EMERGENCIES. 259 

fifth, of the abdomen ; and sixth, of the limbs, or what is known 
as sciatica. 

Causes. Heredity; impoverished condition of the blood; ma- 
laria ; syphilis ; metallic poisons ; anxiety ; mental exertion, ex- 
posure to cold and damp; injuries of the nerve trunk. 

The old axiom is considered true today, with regard to the 
cause of neuralgia, that it is "the cry of the nerves for pure 
blood." 

TIC DOULOUREUX. 

This is a very severe form of neuralgia, accompanied by sharp 
pain, darting and stabbing in character. Its most common loca- 
tion is over the eye and the side of the face. It is attended with 
an increased secretion of tears, twitching of the eye-lids, and often 
pufrmess under the lids also. 

The second form of neuralgia is paroxysmal also, and pain is 
severe; it is located generally in the back of the head, and also on 
one or both sides, and extends from the back of the head down to 
the neck and shoulder, and upwards around the face as far as the 
cheek. 

The third form is also paroxysmal, the pain being severe, and 
burning in character. It extends from the shoulder down the arm, 
and along the side of the chest, while over the latter may be felt 
spots of tenderness. 

In the fourth form the pain is very much the same, but located 
in a different place — along the back, extending along the spinal 
nerves, where they emerge from the spinal cord. 

Treatment. Life is very seldom compromised by neuralgia, but 
when it is present, it causes intense suffering, and the general 
health may be seriously affected. When it occurs in early life, and 
there is no hereditary taint connected with it, the indications are 
that a recovery will take place. The treatment will depend upon 
the cause. Should the blood be impure, as is frequently the case, 
a liberal diet, with medicines to build up the system, such as quin- 
ine, iron and strychnine, as indicated in the following prescrip- 
tions : sometimes plasters are beneficial, also the electric current, 
and liniments, and very often hot water applied will give more 
relief, temporarily, than anything else. 



260 MEDICAL AND SURGICAL EMERGENCIES. 



HYPOCHONDRIA. 

This is an affection of the nervous system characterized by the 
belief that one has some bodily ailment or disease. The patient has 
spells of moodiness. It is similar to melancholia. 

Monomania, or insanity upon one subject, is another evidence 
of the same condition. Rheumatism, headache, mental stupor, 
lack of resolution, hysteria, are a result of the same cause. 

Cause. A gradual loss of nerve control resulting from the 
irritating effects of indigestion and retained waste. 

A lack of proper nourishment reduces the vitality and physical 
force below par, and the patient is unable to exercise proper con- 
trol of himself. The brain becomes clouded and dull, and intelli- 
gent guidance is more or less disturbed, that is, the patient is 
unable to exercise proper control of his actions. 

Treatment. The treatment suggests itself. It consists of atten- 
tion to diet, digestion and elimination, also an abundance of pure 
water, fresh air, sunshine and proper exercise. 

Drug medication may be required and should be prescribed by a 
physician. Chloral, the bromides and asafetida are probably the 
best remedies. 

HYSTERIA. 

As a disorder of the nervous system it is generally confined to 
women, usually occurring in paroxysms, but in very nervous 
women approaching a chronic state. A paroxysm may vary from 
moaning and gesticulation to violent struggling. There may also 
be slight twitching of the muscles, and in some cases general con- 
vulsive movements. 

Consciousness is never wholly lost, and the paroxysm is be- 
lieved to be more or less under the control of the patient, who, if 
instead of giving way to her feelings, would endeavor to control 
them, might possibly escape a paroxysm altogether. 

Hysteria may, however, be developed during the course of an 
organic disease, when, owing to a weakened condition, the patient 
is less accountable for lack of self-control. 

Treatment. A five-grain pill of asafetida taken three times a 
day will generally control hysteria. 



MEDICAL AND SURGICAL EMERGENCIES. 261 

Bromide of ammonia, 2 drachms. 
Aromatic spirits of ammonia, 1 drachm. 
Water, 4 ounces. 
A dessertspoonful three times a day. 

Muriate apomorphine, 1 grain. 

Syrup, 4 drachms. 

Water, 10 drachms. 

A teaspoonful as required. Repeat in a few hours if necessary. 

INSOMNIA. 

Insomnia is a disease of the nervous system in which there is 
inability to sleep. This may exist alone or be connected with some 
other affection. It is a sign of disease even if there is no pain or 
other evidence of suffering. It may be the result of mental over- 
work. 

Treatment. If an accompaniment of other disease, the treat- 
ment should be directed to the disease proper. If due to mental 
overwork, chloral or the bromides are the best remedies. 

Of the chloral, 20 grains, well diluted in water, may be given 
at one dose ; of the bromide of potash, 40 grains, also well diluted 
in water, may be given at one dose. Or better, 20 grains of each 
may be given together. If sleep is not produced in two or three 
hours, one-half the dose, 10 grains of each, may be given. 

The patient should be as free from care as possible, should take 
out-of-door exercise, and give special attention to diet, elimina- 
tion, etc. 

A hot bath for twenty to thirty minutes before going to bed, 
often induces sleep. 

Antipyrin, 1 to 2 drachms. 

Syrup orange peel, 1 ounce. 

Cinnamon water, 3 ounces. 

One tablespoon ful every hour or two until effective. 

Bromide of potassium, 4 drachms. 

Hydrate of chloral, 2 drachms. 

Syrup wild cherry, 1 ounce. 

Water, 3 ounces. 

A dessertspoonful in a wineglassful of water at bedtime. 



SKIN DISEASES. 

Acne, Eczema, Hives, Scabies (Itch). 

acne. 

This affection of the skin is the result of an inflammation of 
the sebaceous glands. It most frequently- appears about the time 
of puberty. It is usually chronic in character. 

Cause. Authorities state that acne is accompanied with di- 
gestive disturbances and that it is often associated with chronic 
diseases — anemia, scrofula and tuberculosis are examples. 

It is true that in many cases there may be no actual disease, yet 
there is some disturbance of digestion which results in a produc- 
tion of irritants in some form, and these irritants affect the ter- 
minal or outer ends of the peripheral nerves — those that supply 
the skin. 

Symptoms. The oily secretion of the gland is retained, but 
the retention is attended with inflammation. Inflamed, ugly-look- 
ing pimples are the result. Pustules may occur among the pim- 
ples. In the pustular variety of acne pustules are the rule. 

The face is the part most commonly affected, although the neck, 
back and shoulders may be subject to this eruption. 

Sometimes the color of the secretion which clogs the ducts 
varies from a white or yellowish to a gray or black, the last two 
being the result of dirt which becomes mixed with the secretions ; 
these are known as blackheads. 

Treatment. Avoid fatty foods as much as possible. Keep the 
bowels open freely. Bathe the face often and thoroughly in good 
soap and hot water. Keep the face protected from wind and cold. 
The pimples should not be squeezed or pressed between the finger- 
nails. 

At night after bathing in hot water, dust on a little white pre- 
cipitate and wash it off in the morning. 

262 



MEDICAL AND SURGICAL EMERGENCIES. 263 

Sulphur, 2J drachms. 
Rose water, 1 drachm. 
Make an ointment. Apply locally. 

Sulphur, 2 drachms. 

Pulv. tragacanth, 20 grains. 

Spirits camphor, 2 drachms. 

Liq. calcis, 2 ounces. 

Distilled water enough to make 4 ounces. 

Make an ointment. Apply locally. 

In cases where the skin is oily, the following is recommended : 

Sulphur, 2 drachms. 
Spirits ether, J ounce. 
Alcohol, 3J ounces. 
As a local application. 

Especially applicable to blackheads : 

Sulphuric ether, 1 ounce. 

Carbonate of ammonia, 1 drachm. 

Boric acid, 20 grains. 

Water, 2 ounces. 

Mix and apply locally two or three times a day. 

ECZEMA. 

This is a manifestation of a systemic trouble. The eruption is 
but a local manifestation of a constitutional disease. 

Eczema may attack all ages and classes. There is a catarrhal 
inflammation of the corium, or deeper layer of the skin. First 
there is congestion of the vessels supplying the affected part, pro- 
ducing redness. In this variety there is a slight exudate from 
the swollen vessels, and when the moisture dries it forms in scales. 

The scales are composed of the solid elements from the blood, 
of the new cells which have grown as a result of the increased 
blood supply, and of such other matter as may inhabit the skin 
where the exudate occurs. 

There are several forms of eczema, as where it occurs in 



264 MEDICAL AND SURGICAL EMERGENCIES. 

papules or points, where the papules contain fluid, or where they 
contain pus. Sometimes the inflammation and exudate cause the 
outer layer of the skin to become detached and it is cast off, leav- 
ing the inflamed corium, or deeper layer of the skin, exposed. 

This gives a red appearance, which differs from the other forms,, 
as it is a deeper red. If the inflammation is severe enough, some 
of the small vessels may be ruptured and blood may form part of 
the exudate. 

Cause. Any one having eczema must remember that his system 
is not in a healthy condition. More thorough elimination is 
needed and more attention should be paid to diet. In some cases, 
the use of alcohol may have been the starting point; in others,, 
possibly tobacco. Their effects would be produced by their inter- 
ference with digestion. Lack of exercise, too much hard work, 
laziness, or any other condition that tends to disturb the general 
health may produce eczema. 

Symptoms. There is always itching and burning in eczema. 
The diseased area presents no distinct outline or border, but the 
redness fades gradually into the surrounding healthy skin. The 
papules or vesicles that occur in erysipelas may resemble those of 
eczema, but erysipelas presents greater swelling, more heat, and 
the color is a deep red, tense and shiny. The inflammation is 
deeper seated. There is fever and frequent pulse. Erysipelas 
may set in with a chill, there may be nausea, vomiting, an abscess 
may form, or in some cases there may be delirium. 

Eczema presents none of these symptoms. The trouble is con- 
fined to itching, and sometimes a burning sensation, but the evi- 
dence is never severe. 

Treatments. In those cases where vesicles form, or where there 
is much moisture present, the following prescription will be found 
most beneficial : 

Salicylic acid, 10 grains. 

Subnitrate of bismuth, I drachm. 

Powdered starch, I drachm. 

Vaseline enough to make I ounce. 

Mix thoroughly, and apply two or three times a day. 

This ointment will be found satisfactory in the treatment of 
most cases. Careful attention should be given to digestion and 



MEDICAL AND SURGICAL EMERGENCIES. 265 

keeping the bowels regular. Ten grains of salol should be taken 
three times a day. 

2. Wash the diseased area with a solution of bicarbonate of 
soda, one or two tablespoonfuls to a quart or more of tepid water. 
Dry very gently and apply carbolated vaseline — 5 drops of car- 
bolic acid to 1 ounce of pure vaseline. 

HIVES — NETTLERASH — WHEALS — URTICARIA. 

All of these terms are applied to certain characteristic marks 
which appear in the skin following indigestion. The trouble is not 
dangerous. It usually occurs in children. 

Cause. Indigestion and usually lack of elimination. As a re- 
sult of indigestion, many irritants are present in the circulation. 

These irritants cause dilatation in groups of small blood-ves- 
sels which supply the skin. This dilatation is the result of the 
paralyzing effects of the irritants upon the nerve fibers which con- 
trol the size of the vessels. The dilatation is sudden, hence the 
rapid appearance of the spots, large or small. 

The spots are usually light in the center, and a reddish or some- 
times a bright red color around the border. They may vary from 
the size of a pea to a walnut, or be even larger. 

Symptoms. The sudden appearance of the spots. They may 
disappear as suddenly as they came, and reappear in some other 
part. 

With their appearance there is a tingling, itching and burning 
sensation. The spots are accompanied by digestive disturbances. 

Treatment. A large dose of castor oil, salts, or Seidlitz salts, 
with careful attention to diet. 

2. Salicylate of soda, 3^ drachms. 

Aromatic elixir, 4 ounces. 

Mix. Dose for child five years old, one-third teaspoonful in 
water every three or four hours ; for adult, one teaspoonful every 
three or four hours. 

ITCH. 

Itch is caused by an animal parasite which burrows in the skin. 
These parasites multiply very fast, producing intense itching. 
The affection generally occurs on the hands between the fingers. 



266 MEDICAL AND SURGICAL EMERGENCIES. 

TREATMENT. 

1. Ammoniated mercury, 40 grains. 
Sulphur, 3 drachms. 

Vaseline enough to make 1 ounce. 

Wash the hands, dry, and apply the ointment twice a day or 
oftener. 

2. Sulphur, 2 ounces. 
Lard, 4 ounces. 

Mix and apply freely at night, washing it off in the morning. 

3. Carbolic acid, 10 drops. 
Water, 4 ounces. 

Mix, and apply locally. 

BRONCHITIS. 

Bronchitis means inflammation of the mucous membrane lining 
the air tubes, but does not include the smaller tubes or air cells. 
Usually the inflammation affects only the large and medium-sized 
tubes. Chronic bronchitis may follow the acute form, or may re- 
sult from other causes. 

I Cause. The cause of acute bronchitis is atmospheric changes, 
the same as those which produce other forms of catarrhal colds. 
j Symptoms. The symptoms are those of a common cold, which 
it accompanies. The catarrhal condition of the throat and nasal 
cavities extends downward into the air tubes. Headache is often 
present, there is a feeling of oppression and tightness in the chest, 
and cough begins as soon as the disease enters the bronchial tubes. 
At first the cough is dry, but later it becomes looser and expectora- 
tion is more profuse. There is usually some fever, and respiration 
is increased. 

Treatment. If one is subject to bronchitis, he should pay imme- 
diate attention to a simple cold and try to prevent it from extend- 
ing to the bronchial passages. If an acute attack occurs, the patient 
should be given a hot mustard foot-bath, and it is well to have the 
air of the room moistened with hot vapor, as steam from a kettle 
of boiling watetr. Bathe the throat and chest freely with cam- 
phorated oil and protect with flannels. 



MEDICAL AND SURGICAL EMERGENCIES. 267 

Chloride of ammonia, 2 drachms. 
Fluid extract licorice, 2 drachms. 
Water enough to make 3 ounces. 
Teaspoonful every four hours. 

PNEUMONIA 

Pneumonia is an inflammation of a part of one or both lungs. 
It is seldom that both lungs are involved. The right lung is di- 
vided into three lobes and the left into two. An acute localized 
inflammation of one or more entire lobes is called lobar pneumonia. 
This is the form usually spoken of as pneumonia. 

The affected portion of the lung becomes solid and firm, no air 
passing through it. Double pneumonia is usually fatal. 

Pneumonia is an inflammation of the air cells, and cannot exist 
without producing bronchitis (inflammation of some of the smaller 
tubes), though bronchitis can, and usually does exist without 
pneumonia, the inflammatory process stopping before it reaches 
the smaller tubes and cells. 

Cause. The irritation produced by any of the conditions which 
cause chronic bronchitis may assume an acute form and produce 
pneumonia. Pneumonia is always the result of an unhealthy 
system. 

The blood contains an excess of irritants, and there is only 
needed an exciting cause, such as a cold, to precipitate acute in- 
flammation of the lungs. Another cause for pneumonia is found 
in the double circulation with which the lungs are supplied, and 
the fact that nearly all the blood in the body passes through these 
organs once every minute. 

Symptoms. The disease usually begins with a chill, followed 
by fever and pain, which is increased by the cough which devel- 
ops. The temperature rises rapidly. At first the pulse is full and 
strong, but may show early signs of embarrassed heart action. 
Respiration is shallow and rapid. The cough is harsh at first, but 
soon a frothy mucus appears, which later becomes thick and 
tenacious. There may be headache, sleeplessness and delirium. 
With children convulsions may take the place of the chill. 

Treatment. Send for the doctor at once. In the meantime put 
the feet in water as hot as can be borne, afterwards rub and dry 



268 MEDICAL AND SURGICAL EMERGENCIES. 

them thoroughly, put the patient to bed, cover warmly and keep 
quiet. Give hot herb drinks and apply hot applications to the 
chest — hot cloths or poultices of mustard or flax-seed. 

HAY FEVER. 

So called because it usually occurs during the haying season. 
The only difference between asthma and hay fever is that in hay 
fever there is a slight rise in temperature and a catarrhal condi- 
tion of the eyes, nasal cavities, throat and air tubes of the lungs, 
but mostly in the air passages of the head. At first the mucous 
membrane may seem dry, but this is followed by an increase in 
the secretions. In some cases there is a profuse, watery discharge. 
Hay fever sometimes assumes all the seriousness of asthma. 

Treatment. Change of climate affords the greatest relief. 

Muriate of quinine, 4 to 8 grains. 
Water, 1 ounce. 
Use with atomizer. 

Antipyrin, -| ounce. 

Syrup orange peel, 1 ounce. 

Water, 3 ounces. 

A teaspoonful once to three times daily. 

SICK HEADACHE. 

There is a variety of causes which may produce sick headache. 
Usually it is due to disturbances of digestion and is spoken of 
as bilious headache. Exacting mental labor, worry, or insuffi- 
cient sleep may induce an attack of sick headache by interference 
with digestion or elimination. Defects of vision when glasses are 
needed, or the wearing of glasses which have not been properly 
fitted to the eyes, is the cause of much headache, and in case of 
severe eye strain, of sick headache. Irritation of the ovaries or 
womb is another cause of headache. 

Treatment. Nervous headache. Hot pack, dark room, bed and 
something to quiet the nerves. 

Sick headache. Hot water internally, or emetic. 



MEDICAL AND SURGICAL EMERGENCIES. 269 

BURNS AND SCALDS. 

The danger arising from burns depends much upon the extent 
of the surface burned and the depth of the injury — if very exten- 
sive and deep, the patient may never rally ; or if flame to any con- 
siderable extent has been drawn into the lungs, the probability is 
that the person cannot be saved. The teaching is that where a 
burn covers one-third of the surface, death is almost sure to follow. 

The great danger from large burns is blood poisoning. All the 
tissues destroyed soon commence to decompose and many poisons 
are produced. These poisons are rapidly absorbed into the circu- 
lation, and this produces a condition of blood poisoning that may 
result fatally. 

Treatments. In the case of a severe burn or scald, if nothing 
else is at hand, apply cold water immediately and but little inflam- 
mation will follow. If one is burned by spilling hot tea or coffee, 
do not wait to remove clothing, but dash cold water on at once. 
This will prevent the hot clothing from burning deeper and pro- 
tect the skin at the same time. Lift the clothing and pour on more 
water, then remove the clothing and apply cold water by wetting 
cloths and laying over the surface. The cloths applied must be 
kept wet without removing them. Cold milk is better than cold 
water because it is thicker and offers better protection. 

To secure benefit from this treatment it must be applied almost 
immediately — quickly enough to arrest the heat before the skin 
has been destroyed. Otherwise it will not be so valuable as lime 
water and linseed oil, baking soda and other treatments. 

For pain following burns and scalds nothing gives greater re- 
lief than the application of cold sweet milk. This may be applied 
•on a cloth frequently changed, or when possible, immerse the in- 
jured surface in a vessel containing the milk. The application 
should be continued until there is freedom from pain, and followed 
by dressings of some mild, soothing antiseptic. 

2. If burn is severe, cover surface with dry baking soda, and 
t>ind lightly with a soft cloth. 

1 3. Use equal parts of lime water and linseed oil. Saturate 
■cloths and lay over the burn. Keep cloths wet by pouring on the 
.solution. Do not take dressing off every day. If blisters form 



270 MEDICAL AND SURGICAL EMERGENCIES. 

open at base to let fluid out. Do not make a large opening. After 
heat is out, dry boracic acid makes a good application. 

4. Apply distilled witch hazel every few minutes. This will 
stop all smarting, even in the case of a burn from hot grease. 

5. Common washing soda or baking soda, three tablespoonfuls 
to a pint of water. Apply freely. 

6. If clothes stick to the flesh do not tear them off, but flood the 
part with olive oil. 

7. Lay on cloths wet in olive oil and laudanum. To heal burns, 
apply an ointment made as follows: 

Vaseline, 1 ounce. 

Oxide of zinc, 1 drachm. 

Mix thoroughly and spread on linen cloths and apply to burns. 

In case of scalds, exclude the air at once with soda and flour, 
covering the parts and keeping them covered. 

white; swelling. 

This form of inflammation is always chronic, and occurs only in 
those previously unhealthy. In recent years white swelling is 
understood to mean tuberculosis or consumption. Consumption 
is a degenerative change which usually occurs in the lungs, but 
may occur in any other tissue or part. Occurring in a joint, it may 
first affect the bone, the membrane surrounding the joint, or any 
other structure entering into the joint formation. The low form 
of inflammation present first results in an overgrowth of con- 
nective tissue; later the new tissue and more or less of the joint 
structure softens and degenerates, the ligaments become relaxed 
and softened, and there is deformity in proportion. In some cases 
a large amount of fluid may collect during the earlier stages ; in 
others there may be early degeneration of some part of the mem- 
brane surrounding the joint. This results in an opening which 
may continue to the surface, forming a sinus, from which later 
there is a more or less constant discharge of pus. 

In all cases the joint is swollen and the skin thickened and firmly 
adherent to the deeper structures as a result of the low form of 
inflammation which has existed for some time. There is no red- 
ness because the disease is chronic. Nutrition is more or less lack- 



MEDICAL AND SURGICAL EMERGENCIES. 271 

ing, circulation is poor, and the color is lighter than normal, hence 
the term white swelling. 

Treatments. The treatment is both general and local. The local 
treatment consists first of rest. Plaster casts and other forms of 
splints are recommended by some and objected to by others. A 
common seat of the disease is the knee joint, and here extension is 
valuable as in the treatment of hip joint disease. If there is no 
improvement at the end of one month, most surgeons advise in- 
jecting into the joint some form of antiseptic solution, usually a 
10 per cent, solution of iodoform in glycerine. Some advise in- 
jecting balsam of Peru. The iodoform and balsam combined 
make a most excellent disinfectant and local stimulant. In those 
cases where there is a large collection of fluid, it should be re- 
moved by an aspirator. This local treatment, while recommended, 
often fails to cure, and in some cases affords no relief. 

The real treatment consists in improving the system by atten- 
tion to diet, elimination, fresh air, etc. There is always more or 
less stiffening of the joint in which the disease occurs, as the re- 
sult of the overgrowth and contraction of connective tissue, or the 
destruction of bone, tendons and ligaments, or of all combined. 

The following liniment may be used, bathing the affected part, 
night and morning, rubbing the liniment in well. 

Turpentine, 1 ounce. 
Tinct. Spanish fly, 1 ounce. 
Sweet oil, 1 ounce. 
Laudanum, 1 ounce. 

HEMORRHOIDS OR PILES. 

Piles are tumors situated about the anus or just within the rec- 
tum. The former are external piles, the latter, internal piles. 
Both varieties may exist at the same time. In some cases these 
tumors break and blood is discharged from them, in which case 
they are spoken of as bleeding piles ; if there is no discharge of 
blood, and they remain internal, they are spoken of as blind piles. 

Cause. What seems to be an imperfection in the anatomical 
structure of the veins surrounding the rectum is the primary cause 
of this trouble. 

The veins throughout the body and lower extremities are well 



^2 MEDICAL AND SURGICAL EMERGENCIES. 

supplied with little valves which prevent a return of the blood, but 
for some unknown reason those surrounding the rectum are not 
thus supplied. The absence of these valves favors congestion, and 
the veins gradually bulge until small sacs are formed. 

Everything that irritates the lower bowel, as strong physics, 
habitual constipation and any of the causes which tend to produce 
it, as straining at stools, etc., will cause an increase of blood in 
this part and a consequent congestion, and piles are the usual re- 
sult. 

Symptoms. Pain, often a burning sensation, and a protuberance 
of the pile. Usually there is hemorrhage, which may be slight or 
very profuse. If the hemorrhoids are large and remain internal, 
there will be a constant desire to evacuate the bowels, as the sen- 
sation is the same as though the mass consisted of fecal matter. 

An examination will reveal the' true condition. 

Treatments. All conditions are benefited by the free use of in- 
testinal antiseptics : 10 grains of the sulphocarbolate of soda, in 
tablet form, or the same amount of salol, either in tablet form or 
powder, should be taken four times a day. 

To insure greater regularity of bowel movement, avoid meats 
and all heavy foods for supper. By eating light suppers difficul- 
ties of constipation are more readily overcome. 

Local applications. The following ointment will be found of 
value in many cases of piles : 

Vaseline, i ounce. 
Nut-galls, pulv., 80 grains. 
Pulverized opium, \ drachm. 

Mix together thoroughly, use after each movement of the 
bowels. 

If the bowel comes down, put it back, carrying it up with the 
index finger as far as possible. 

Cocaine hydrochlorate, 12 grains. 
Iodoform, 1 drachm. 
Extract opium, 30 grains. 
Petroleum, 1 ounce. 
Use as a salve. 



MEDICAL AND SURGICAL EMERGENCIES. 27s 



APPENDICITIS. 

The appendix is a narrow tube, usually from two to four inches 
in length, and in diameter about the size of a goose quill, or a little 
larger. It is situated in the abdominal cavity, rather low down 
and toward the right side. Appendicitis is inflammation of the 
appendix. Sometimes appendicitis occurs more than once in the 
same person, this is called recurrent appendicitis. If possible the 
appendix should be removed between the attacks. 

Cause. The first cause of appendicitis is indigestion ; following 
this is an unhealthy condition of the digestive tract. Constipation 
results, with the production of many poisons and irritating sub- 
stances. This condition causes inflammation which extends along 
the digestive tract and into the appendix. 

Symptoms. Sudden onset of pain in the abdominal cavity. 
Nausea and usually vomiting. Fever. 

Treatment. A physician should be called at once. The patient 
should be put to bed and kept as quiet as possible. 

All cases of appendicitis may be divided into three classes : First, 
those which are fulminating or gangrenous, and almost invariably 
result in death. Second, those which need a surgical operation. 
Third, those which get well, some permanently so, under proper 
medical treatment. In cases of this third class, the patient should 
be put to bed and absolute rest upon the back insisted upon. He 
must not rise to the sitting posture. An ice-bag should be placed 
over the appendix and such medicine given as directed by 
physician. 

The patient should receive a diet of broths or beef-tea, instead of 
milk, as the latter is apt to cause fermentation and the formation 
•of gas in large amounts in the intestine. 

GREEN SICKNESS OR CHLOROSIS. 

This is a term applied to a particular form of anemia, often 
distinguished by a greenish-yellow coloration of the skin. It 
occurs in young persons, chiefly girls about puberty. It is an 
anemic condition of a pronounced type. 
18 



274 MEDICAL AND SURGICAL EMERGENCIES. 

Cause. Disturbances of nutrition beginning with indigestion 
and constipation. 

Symptoms. The skin assumes a pallid hue, the flesh becomes 
flabby and the countenance, after the menses, which are either 
scanty or suppressed, has a greenish-yellow cast. There is no loss 
of flesh ; instead the patient sometimes takes it on. 

The feet and legs have a tendency to swell, the patient tires 
easily, has palpitation on slight exertion, the appetite is usually 
depraved, the digestion impaired and constipation the rule. 

Gastric ulcer may occur, and consumption, especially in those 
predisposed, is a common result. 

Treatment. The treatment consists in nourishing diet and every 
attention to the general health. Any of the following remedies 
may be taken to advantage : 

i. Extract aloes, I drachm. 

Sulphate of iron, 2 drachms. 

Asafetida, 4 drachms. 

Divide into 100 pills. From one to three pills three times a day. 

2. Under the name of "Dewee's Emmenagogue Mixture," first 
devised by Professor Dewees of Philadelphia, the following 
formula has been largely used : 

Tinct. chloride of iron, 3 drachms. 

Tinct. catharidis, 1 drachm. 

Tinct. ammonia guaiac, i| drachms. 

Tinct. aloes, ^ ounce. 

Syrup enough to make 6 ounces. 

Tablespoonful three times a day. 

3. Tinct. chloride of iron, J ounce. 
Glycerine, 2 ounces. 

Simple elixir, add to 4 ounces. 

Give one teaspoon ful after meals and at bedtime. 

4. Fellow's syrup of hypophosphites, 5 ounces. 

Maltine, or a good preparation of extract of malt, 10 ounces. 
Shake the bottle and take a tablespoonful after meals and at bed- 
time. 



MEDICAL AND SURGICAL EMERGENCIES. 275 

5. Blaud's pills, 5 grains each. 

Take one after each meal and at bedtime. Four a day. 

jaundice. 

Jaundice is a condition resulting from obstruction of the bile 
passages. It is characterized by a yellow discoloration of the skin, 
preceded or accompanied by languor, and often with nausea. 
There is also a yellowish tinge to the white of the eye. Constipa- 
tion is usually present. 

Cause. The cause is congestion of the bile ducts ; or the con- 
gestion may be confined to that portion of the duct that opens into 
the bowels. It is a catarrhal condition, and the catarrh is the same 
as may exist elsewhere. There is congestion, and a greater or less 
amount of mucus secretions collect in the tubes and obstruct the 
flow of bile. The catarrh may result from excessive eating fol- 
lowed by indigestion, from using too much alcohol, may be caused 
by malaria, or may be the result of taking cold. 

Symptoms. The symptoms are nausea, loss of appetite, and 
slight fever. There may be diarrhea or constipation, usually the 
latter. There is a yellowish color to the skin, which also shows in 
the whites of the eyes. There may be more or less pain in the 
region of the stomach and bowels. The mind becomes dull and the 
patient is languid. The urine contains bile. 

Treatments. An active cathartic should be given at once, such 
as a single dose of calomel of five to ten grains. The patient 
should diet for a few days and secure an abundance of fresh air. 
After securing thorough action from the calomel, the patient should 
take one teaspoonful of phosphate of soda dissolved in one-half 
to two-thirds of a glass of water. This should be taken one hour 
before each meal. The dose may be increased or diminished as 
found necessary. This remedy has a special action on the liver, will 
relieve the congestion and insure increased activity along the whole 
digestive tract. Tonics may be needed for a few days. For this 
purpose give the following : 

Tinct. of gentian^ 1 drachm. 

Tinct. of columbo, 1 drachm. 

Elixir of calisaya bark, enough to make 2 ounces. 

Take one teaspoonful before meals. 



276 MEDICAL AND SURGICAL EMERGENCIES. 

ENLARGED TONSILS. 

Sometimes the tonsils remain permanently enlarged. In this 
case it is better to have them removed. The operation is neither 
difficult nor painful. Until this is deemed necessary, either of the 
following may be used to advantage: 

Treatments. 

Chlorate of potash, \ teaspoonful. 

Sulphite of soda, 1-3 teaspoonful. 

Put into a glass and fill with warm water Gargle the throat 
thoroughly with a tablespoonful of this solution from three to five 
times a day. 

Also paint the tonsils once in two or three days with the tincture 
of iodine, using a small brush. To do this, take a spoon handle, or 
something of the kind, and press the tongue down so that the 
tonsils may be treated readily. 

Iodine, 2 drachms. 

Glycerine, 6 drachms. 

Mix and apply daily with a brush. 

BROKEN BREASTS. 

The mammary glands for the secretion of milk in the breasts 
-consists of ducts, ten or twelve in number each, called lactiferous, 
meaning milk-bearing. These ducts terminate externally at the 
nipple ; internally, they branch into minute tubes like the roots of 
a tree. After delivery the increased nutrition that nature had pre- 
viously secreted in the uterus is diverted to the mammary glands 
for the sustenance of the child. 

Cause. If it happens that there is an excess of secretion in the 
"breasts, the milk tubes become choked and distended with it. This 
may result in an inflammation of the glands, and in some cases the 
patient is subject to a sharp febrile attack, called milk fever. In- 
flammation may also result from checking the flow of the milk too 
early, from exposure, from mental disturbance, as worry, fright, 
or undue excitement; also from external injury or pressure from 
too tight clothing. 

Symptoms. Severe local pain, increased by pressure, is caused 



MEDICAL AND SURGICAL EMERGENCIES. 277 

by the inflammation, and usually there will be found a hard swel- 
ling. The tendency is toward suppuration, the fever increasing 
with the formation of the abscess. If the abscess breaks the con- 
dition is known as "broken breast." 

Treatment. Hot poultices, or heat in some form is most excel- 
lent treatment and always safe. Cold is also valuable if applied 
early. The first real evidence of inflammation of the breast is the 
presence of one or more small hard lumps. If a thin sack of ice 
is laid over- the breast at this time and kept there, it will prove very 
effectual; in fact, applied early, it is the ideal treatment. There 
need be no fear about taking cold. A laxative should be given 
early. When poultices are used the applications must be thorough. 
Gradually increase the heat as long as can be borne. Change the 
poultices often, every five or ten minutes, depending upon the size. 

TOE-NAIL, INGROWING. 

This difficulty usually occurs on the great toe. In some cases 
it is very painful. In every case the condition is unpleasant and 
there is always more or less soreness and pain. 

Cause. The edge of the nail either grows down into the tissues, 
or the tissue grows up over the edge of the nail ; both conditions 
may be present. 

Treatment. Very many cases may be benefited and often cured 
by taking a sharp-pointed knife and, by repeated strokes along the 
border gradually cutting through the nail, removing a strip from 
one-sixteenth to one-eighth of an inch in width, and sometimes 
more. 

Where the nail grows down into the tissue it is not attached on 
either side, and by cutting through, the sliver of nail may be readily 
removed. This relieves the pressure, and for a time relieves the 
pain and soreness. If the trouble recurs, repeat the treatment. 
If successful the first time, it will be successful every time, and 
eventually the nail will stop growing in that direction. Some cases, 
however, need surgical treatment. 

Henry Finch, M. D., reports, through the British Medical 
Journal, a method which he has followed in numerous cases with 
uniform success. 

If a small, thin, flat piece of silver plate be bent at one edge into 



278 MEDICAL AND SURGICAL EMERGENCIES. 

a slight, deep groove and, after the toe has been poulticed twenty- 
four hours, slipped beneath the edge of the nail so as to protect 
the flesh from its pressure, and the rest of the thin plate bent 
around the side and front of the toe, being kept in position with a 
small portion of adhesive plaster passed around the toe, a speedy 
and almost painless cure will take place ; and the patient, after the 
first day, is able to walk. 

PREPARATION OF BOTTLED MIUC 

From birth to the third or fourth month : 
Milk, fresh, 8 tablespoonfuls. 
Lime water, fresh, 2 tablespoonfuls. 
Water, boiled, 30 tablespoonfuls. 
Milk sugar, pure, 9 even teaspoonfuls. 

From the fourth to the ninth month : 
Milk, fresh, 16 tablespoonfuls. 
Lime water, fresh, 2 tablespoonfuls. 
Water, boiled, 22 tablespoonfuls. 
Milk sugar, 9 even teaspoonfuls. 

Amount to be given. Enough of either of these to last for the 
day should be placed in a clean bottle or fruit can, one that has 
been thoroughly scalded, the bottle or can placed upright in a ves- 
sel containing a few inches of water, and the water heated to the 
boiling point. The bottle should then be taken from the fire, cooled 
quickly and kept tightly corked in a cool place. The number of 
tablespoonfuls of the mixture put into the feeding bottle should be 
as follows : 

For the first week, 2 to 3 tablespoonfuls. 
Second to sixth week, 3 to 7 tablespoonfuls. 
Sixth to twelfth week, 8 to 9 tablespoonfuls. 
Third to sixth month, 8 to 12 tablespoonfuls. 
Sixth to ninth month, 12 to 18 tablespoonfuls. 

APHTHAE — THRUSH — CANKER SORE MOUTH. 

This is a disease of the mouth in which small vesicles appear. 
These vesicles may ulcerate. If ulceration takes place, it is called 



MEDICAL AND SURGICAL EMERGENCIES. 279 

aphthae or thrush ; if ulcertion does not take place, it is spoken of 
as canker sore mouth. 

Causes. It is a disease of infancy and may follow a catarrhal 
condition of the stomach, or may result from a lack of cleanliness 
of the mouth. It may also be caused or influenced by indigestion 
and an unhealthy condition of the bowels. Also said to be caused 
by teething. 

Symptoms. The child may refuse to nurse, and small vesicles 
appear in the mouth — on the tongue, gums, lips and mucous mem- 
brane of the cheek. The vesicles are first of a light color. If 
ulcers form they are quite painful. There is no odor. The child 
may worry a good deal and in some cases is quite troublesome. 

Treatments. Regulate the stomach and bowels, give good ven- 
tilation, and wash the mouth with the following mixture : 

Borax, powdered, 1 drachm. 

Lloyd's hydrastis, 4 drachms. 

Glycerine, 2 drachms. 

Water enough to make 2 ounces. 

Apply this with a soft cloth several times a day. The child's 
mouth should also be washed with a little warm water after 
nursing. 

To regulate the bowels give the following mixture : 

Carbonate of soda, 1 drachm 
Wine of ipecac, I drachm. 
Fluid hydrastis, 6 drachms. 
Syrup of rhubarb, enough to make 4 ounces. 
Dose. Ten drops to one-half teaspoonful twice a day, according 
to age. 

The above is applicable either to the ulcerated or simple form. 

URINE, INCONTINENCE OE. 

This means an involuntary evacuation of the bladder, although 
it is generally understood to mean inability to retain the urine 
during sleep. This is a disease of childhood and is overcome with 
age, but may also be relieved by treatment. 

Causes. Phimosis (a long prepuce or foreskin), adhesions of 



28o MEDICAL AND SURGICAL EMERGENCIES. 

the prepuce, intestinal worms, or oversensitiveness of the urethral 
tract. These and other causes are given, although in many cases 
there can be no cause discovered. Possibly some cases are due to 
a lack of development of the nerve fibres which supply the neck of 
the bladder, hence the constrictory muscle is not under proper con- 
trol. Or, this nerve supply might be oversensitive, hence the pres- 
sure resulting from a distended bladder would allow or cause an 
involuntary passage of the urine during sleep. 

Treatment. In the treatment of this trouble atropine has proven 
very successful. It is well to give a dose of santonine for one or 
two nights. If there are any worms present, it will remove them 
without trouble ; if there are none, it will do no harm. Santonine 
is a remedy used by some for this trouble whether caused by 
worms or not, and is even claimed to be successful where atropine 
fails. If atropine is used, it should be given in several small doses 
frequently repeated, commencing two or three hours before the 
child goes to bed ; or one large dose may be given. The small dose 
is preferable, as there would then be no danger of overdosing. For 
a child from five to ten years old, give 1-500 of a grain every hour 
until the pupil of the eye is well dilated, or until the face is flushed, 
and give at bed-time one grain of santonine and one grain of calo- 
mel. In some cases it is necessary to repeat the atropine for some 
days. If the two or three doses of atropine do not produce the 
symptoms mentioned, begin the treatment earlier the second day 
and continue until effect. 

RETENTION OF URINE. 

In most cases with infants, retention of urine may be overcome 
by giving liberally of a tea made of pumpkin or watermelon seeds. 
Sometimes the urethral tract in the new-born male child is not 
complete, i. e., does not reach the surface. In such a case the 
physician should make an artificial opening, being careful to have 
it meet the natural opening. 

VEGETARIANISM. 

An English physician in commenting on what we gain, from a 
health standpoint, by becoming vegetarians, makes the following 
statements : 

"We lose most stomach complaints, such as indigestion, ulcera- 



MEDICAL AND SURGICAL EMERGENCIES. 281 

tion and cancer of this organ. I do not mean to say, that because 
you are a vegetarian you will lose all stomach complaints, but by 
adopting a non-flesh diet, the number of these complaints will be 
considerably lessened and their severity diminished. 

"Fish, flesh and fowl are almost entirely digested only in the 
stomach, therefore, any one who adopts a non-flesh diet will lessen 
the work of the stomach, and by so doing lessens the liability to 
diseases of this organ. 

"Rheumatism and gout are practically unknown to vegetarians 
and one who is subject to these diseases may overcome his trouble 
by adopting a proper non-flesh diet. 

"Hardness of the arteries and tendency to apoplexy are greatly 
lessened by vegetarian diet. 

"Obesity or stoutness is rare among vegetarians. Abnormal 
thinness is also unknown. This seems to be the rule, that the very 
stout are reduced in flesh and the very thin are brought up to a 
heavier standpoint. 

"Liver troubles are rare among vegetarians, such as biliousness, 
jaundice, enlarged liver, shrunken liver and gall stones. 

"Kidney complaints are uncommon, be they diabetes, albumin- 
uria, stone in the kidney or in the bladder. 

"Heart diseases are rare, such as valvular diseases, functional 
disorder, enlarged heart and tachycardia, which is known by the 
attacks of rapid beating of the heart. The heart of the vegetarian 
beats more slowly than that of the meat eater, and by this slow 
action the life of the vegetarian is prolonged. Dropsy and like 
troubles arising from the heart are also lessened. 

"Nerve diseases are less frequent in vegetarians than in meat 
eaters. The vegetarian is less nervous, less sleepless, less irritable, 
less excitable and worries less than the average meat eater. 

"Chorea, or St. Vitus' dance, is less often seen in vegetarian 
children than in those of meat-eating families. 

"Anemia is less common among vegetarians than in meat eaters. 
Some doctors say that the green vegetables and the pulse foods 
contain iron in a state that can be used by the blood, and so this 
complaint is kept away. 

"Goitre is not common in vegetarians. 

"Skin troubles are greatly lessened, but not entirely banished by 
a non-flesh diet. 



282 MEDICAL AND SURGICAL EMERGENCIES. 

"Insanity is very uncommon among vegetarians. Drunkenness 
is practically unknown ; infectious diseases are milder in kind and 
of shorter duration than among meat eaters. 

"Cancer is all but unknown among vegetarians. The diet makes 
his teeth better, they last longer and he suffers less from neuralgia 
and toothache than flesh eaters. 

"In fact, a vegetarian diet and observance of health rules add 
from ten to fifteen years to a person's life." 



THE ERUPTIVE FEVERS. 



SCARLET-FEVER. 

Period of incubation, four to seven days or shorter. 

Mode of onset, sudden ; very often at night ; sore throat ; vomit- 
ing ; convulsions in severe cases ; high fever. 

Eruption appears, at the end of first or during the second day. 

Eruption fades in three to five days ; disappearing first where it 
first appears. 

Danger of contagion. So long as desquamation continues, or a 
purulent discharge from the ear or an abscess keeps up ; indefinitely 
in clothing, toys, books, etc;, which have not been disinfected. 

MEASLES. 

Period of incubation, eight to ten days. 

Mode of onset, rather sudden; catarrhal symptoms; moderate 
fever. 

Eruption appears fourth day; less commonly on third 
or fifth. 

Eruption fades, in about four days. 

Danger of contagion. So long as desquamation lasts. 

GERMAN OR FRENCH MEASLES. 

Period of incubation, two or three weeks. 

Mode of onset, gradual; fever slight and transient; sometimes 
absent. 

Eruption appears, the eruption usually the first symptom. 

Eruption fades, in about four to six days without desquama- 
tion. 

Danger of contagion. The duration of the liability to communi- 
cate the disease is not known. 

283 



284 MEDICAL AND SURGICAL EMERGENCIES. 

SMALLPOX. 

Period of incubation, ten to fourteen days. 

Mode of onset, sudden; chill; high fever; headache; pain in 
loins, etc. 

Eruption appears, on the third or fourth day ; typical evolution,, 
about the sixth day or the ninth of the disease characteristic pus- 
tules fully formed. 

Eruption fades, desiccation at end of second week ; crusts slowly 
separate, leaving marked and enduring cicatrices. 

Danger of contagion. So long as crusts reform ; indefinitely in 
fomites, etc. 

VARIOLOID (MODIFIED SMALLPOX). 

Period of incubation, ten to fourteen days. 

Mode of onset, sudden; chill; high fever; headache; pain hx 
loins, etc. 

Eruption appears, third or fourth day; typical evolution, about 
the sixth day or the ninth of the disease, characteristic pustules 
fully formed. 

Eruption fades, pocks do not go on to suppuration, but begin 
to dry up from the vesicular stage, that is, the sixth or eighth day 
of the disease. 

Danger of contagion. So long as crusts form ; indefinitely iti 
fomites, etc. 

CHICKEN-POX. 

Period of incubation, about two weeks. 

Mode of onset, sudden. 

Eruption appears, at once and often in successive crops. 

Eruption fades, in a few days; dessication, as a rule, without 
suppuration. 

Danger of contagion. Duration of danger of contagion ends 
with the shedding of the dried crusts. 



VERY VALUABLE PRESCRIPTIONS. 

The following will be found to be very valuable prescriptions 
for the diseases for which they are intended. They are selected 
from those in use in the leading hospitals of Great Britain and the 
United States and also from those used by the leading specialists 
and general practitioners: 

BRONCHITIS. 

^ No. i. 

Morphine sulphate, one grain. 
Ammonia chloride, one drachm. 
Fluid extract grindelia robusta, four drachms. 
Syrup wild cherry, two drachms. 
Mixture licorice compound, two drachms. 
Teaspoonful for cough. Especially useful in acute bronchitis. 

^ No. 2. 

Morphine sulphate, one grain. 
Chloral, one drachm. 
Syrup ginger, four drachms. 
Mixture licorice, one fluid ounce. 
Teaspoonful every half-hour until relieved. For spasmodic 
asthma. 

I£ No. 3. 

Cod-liver oil, two ounces. 

Sugar, six drachms. 

Acacia, four drachms. 

Oil gaultheria, fifteen minims. 

Water, to make four fluid ounces. 

Emulsion of cod-liver oil. Mix the sugar and acacia thoroughly 
vyith one-half the amount of water until a uniform mucilage is 

285 



286 MEDICAL AND SURGICAL EMERGENCIES. 

formed; then add the oil slowly, mixing constantly, and subse- 
quently add the remainder of the water. It requires about an hour 
to make the perfect emulsion, to which may be added lacto-phos- 
phate of calcium or phosphoric acid, which will give it an agree- 
able acidulous taste. 

tf No. 5. 

Morphine sulphate, one grain. 
Ammonia carbonate, thirty grains. 
Syrup wild cherry, four drachms. 
Mixture licorice compound, four drachms. 
Teaspoonful in water for cough. Very useful when opiates can 
be used. 

FOR CATARRH OF NOSE AND THROAT. 

5 No. 6. 

Tincture aconite, one drachm. 

Tincture belladonna, two drachms. 
Three drops every hour. 

^ No. 7. 

Cocaine muriate, six grains. 
Bismuth subcarb., one-half drachm. 
Talc, one and one-half drachms. 
Enough to cover a silver five cent piece insufflated into each 
nostril every two hours. 

^ No. 8. 

Chloroform, two drachms. 
Glycerine, one ounce. 
Brandy, one ounce. 
One teaspoonful in water every three hours. 

^ No. 9. 

Boracic acid, sixty grains. 
Glycerine, twenty minims. 
Water, six drachms. 
Dissolve with heat and saturate cotton-wool, a thin sheet, with 



MEDICAL AND SURGICAL EMERGENCIES. 287 

the solution and dry. Pack the upper part of the nose with the 
prepared cotton, leaving a space below for breathing. 

^ No. 10. 

Soda bicarbonate, one ounce. 
Insufflate, or apply with finger to inflamed tonsil. 

If No. n. 

Salicylate of soda, two drachms. 

Borax, three drachms. 

Glycerine, four drachms. 

Water, enough to make six ounces. 
A dessertspoonful in pint of water, used with spray or douche. 

^ No. 12. 

Resorcin, five to ten grains. 

Distilled water, two ounces. 
Use with atomizer twice daily, four minutes each time. 

CATARRH OF BRONCHIAL TUBES AND LUNGS. 

I? No. 13. 

Ammonium chloride, three drachms. 

Mucilage acacia, four ounces. 
A tablespoonful four times daily. 

3£ No. 14. 

Ammonia carbonate, thirty-two grains. 
Extract senega fluid, one drachm. 
Extract squills fluid, one drachm. 
Paregoric, six drachms. 
Water, four drachms. 
Syrup tolu, enough to make four ounces. 
A teaspoonful every three or four hours. 

If No. 15. 

Syrup tolu, one ounce. 

Syrup wild cherry, one ounce. 

Tinct. hyoscyamus, one ounce. 



288 MEDICAL AND SURGICAL EMERGENCIES. 

Spts. ether compound, one ounce. 
Water, one ounce. 
A teaspoonful three times daily. 



^ No. 16. 

Tincture opium, three drops. 
Whisky, one ounce. 
Boiling water, four ounces. 
White sugar. 
Take at bed-time. 



GARGLES. 

Gargles are useful only in diseases of the fauces. They cannot 
-affect the nasal passages, or the lower pharynx or larynx. The 
preparations may be sedative, astringent, stimulant or antiseptic. 

Sedative. 

^ No. 17. 

Bromide of potassium, thirty grains to one fluid ounce water. 

^ No. 18. 

Nitrate of potassium, twenty grains. 
Chlorate of potassium, twenty grains. 
Hot water, one fluid ounce. 
Use as hot as it can be borne, as a gargle four times a day. 

Astringents. 

^ No. 19. 

Tannic acid, twelve grains to two drachms to one fluid ounce 
water. 

^ No. 20. 

Alum, eight grains to one fluid ounce of water. 

1J No. 21. 

Borate of soda, twenty-five grains. 
Glycerine, twenty-five minims. 
Tincture of myrrh, twenty-five minims. 
Water, one fluid ounce. 



MEDICAL AND SURGICAL EMERGENCIES. 289 

Stimulants. 

1J No. 22. 

Carbolic acid, two to ten grains to one fluid ounce of water. 

^ No. 23. 
Chlorate of potassium, ten to twenty-five grains to one fluid 
ounce water. 

Antiseptics. 

I£ No. 24. 

Permanganate of potassium, two to four grains to one ounce 
water. 

VAPOR INHALATIONS. 

An inhaler which is commonly used consists of a glass flask 
"holding about a quart. This has a perforated cork through which 
two glass tubes are passed, one to the bottom of the flask to admit 
the air, and the other through which the patient inhales the vapor, 
into its upper part. In the absence of an inhaler an earthen tea-pot 
may be used. 

The inhalations are prepared by adding a teaspoonful of the 
medicated solution to a pint of water at a temperature of about 
150 degrees E., or as indicated by the formula. They should be 
used morning and evening for about five minutes each time, six 
respirations taken each minute. The vapors may be sedative, anti- 
spasmodic, antiseptic or stimulant. 

Sedative. 

If No. 25. 

Tincture benzoin compound, one fluid drachm. 

^ No. 26. 
Paregoric, one fluid drachm. 

Anti-spasmodics. 

^ No. 27. 

Nitrate of amyl eight minims to one fluid ounce. 
19 



290 MEDICAL AND SURGICAL EMERGENCIES. 

Stimulant. 

^ No. 28. 
Terebene, one drachm. 

More stimulating and also antiseptic. 

^ No. 29. 
Creosote, forty minims to one fluid ounce. 

^ No. 30. 
Carbolic acid, thirty grains. 
Chloride of ammonia, thirty grains. 
Glycerine, one drachm. 
Distilled water, one ounce. 

^ No. 31. 

Tincture iodine compound, five minims. 
Glycerine, one drachm. 
Distilled water, seven drachms. 

SPRAY INHALATIONS. 

Spray inhalations are to be used by the physician or patient in 
full strength with the compressed-air atomizer; the aqueous solu- 
tions may be used in about double strength, by the steam atomizer. 
These applications are useful principally in treating diseases of 
the fauces and of the nasal cavities. The inhalations may be 
classified as sedatives, astringents and stimulants, hemostatics, 
and antiseptics. 

Sedatives. 

^ No. 32. 

Bromide of potassium, twenty grains to one fluid ounce. 

^ No. 33. 
Carbolic acid, two and one-half grains. 
Menthol, five grains. 
Liquid albolene, one ounce. 



MEDICAL AND SURGICAL EMERGENCIES. 291 

Astringents and stimulants. 

^ No. 34. 

Tannic acid, three grains to one fluid ounce. 

^ No. 35. 
Sulphate of zinc, two to ten grains to one fluid ounce. 

^ No. 36. 
Chloride of zinc, two to ten grains to one fluid ounce. 

^ No. 37. 
Alum, ten grains to one fluid ounce. 

9 No. 38. 
Morphine sulphate, four grains. 
Tannic acid, thirty grains. 
Carbolic acid, thirty grains. 
Glycerine, four drachms. 
Distilled water, four drachms. 

^ No. 39. 

Carbolic acid, thirty minims. 
Borax, one drachm. 
Bicarbonate of soda, one drachm. 
Glycerine, three and one-half drachms. 
Water, enough to make four ounces. 

CATARRH OF INTESTINES. 

I£ No. 40. 

Liq. potass, arsenitis, one-half ounce. 
One or two drops before meals. 

I£ No. 41. 

Ext. hydrastis fid., one-half ounce. 
Five to fifteen drops before meals, in water. To be continued 
some time. 

IJ No. 42. 

Tinct. capsicum, six drachms. 



292 MEDICAL AND SURGICAL EMERGENCIES. 

5 No-43- 
Tinct. nux vomica, two drachms. 

Two drops every four hours. 

5 No. 44. 

Tinct. opium, sixteen drops. 

^ No. 45. 
Bismuth subnitrate, two drachms. 

^ No. 46. 

Syrup, four drachms. 

^ No. 47. 

Cinnamon water, one and one-half ounces. 
Shake bottle. Give one teaspoonful every two to four hours. 
For child one year old. 

^ No. 48. 
Bismuth subnitrate, two drachms. 
Pulv. ipecac compound, nine grains. 
Divide into twelve powders. One every three hours for child 
one year old. 

CATARRH OF THE) BLADDER. 

5 No. 49. 

Potassii citrate, one-half ounce. 
Spts. chloroformi, two and one-half drachms. 
Tinct. digitalis, eighty minims. 
Infus. buchu, eight ounces. 
Two tablespoonfuls three or four times daily. 

^ No. 50. 

Copaiba, two drachms. 
Spts. lavand. co., two drachms. 
Mucil. acacia, one-half ounce. 
Syrupi simp., three drachms. 
Aquae, four ounces. 
A tablespoonful twice daily. 



MEDICAL AND SURGICAL EMERGENCIES. 293 

^ No. 51. 
Infus. buchu, seven ounces. 
Potassii bicarb., one drachm. 
Tinct. hyoscami, two and one-half drachms. 
Ext. sarsse. fl., four drachms. 
Two tablespoon fuls three times daily. (In irritable bladder with 
acid urine.) 

^ No. 52. 
Fol. hyoscami, one-half ounce. 
Aq. bullientis, one pint. 
Make infusion. A tablespoonful every half-hour for one fore- 
noon, unless throat becomes dry or patient drowsy. 

CHOLERA INFANTUM. 

9 No. 53. 

Tinct. cocae (1 to 5), one ounce. 
Four to six drops every two hours at three months of age. 
Fifteen to twenty drops in older children. 

^ No. 54. 

Salol, six grains. 
Sacch. lactis, ten grains. 
Divide into twelve powders. A powder every two hours for a 
child of six months. 

ty No. 55. 

Hydrarg. chlorid. mit., three grains. 

Cretse praep., thirty-six grains. 

Plumb, acetat., twelve grains. 

Pulv. ipecac, three grains. 
Divide into twelve powders. One every three hours. 

^ No. 56. 
Tinct. opium, sixteen drops. 
Aromatic spirits ammonia, one drachm. 
Bismuth, subnitrate, two drachms. 
Syrup, four drachms. 
Chalk mixture, one and one-half ounces. 



294 MEDICAL AND SURGICAL EMERGENCIES. 

Shake well, give teaspoonful every two or three hours to child 
eight to twelve months old. 

ty No. 57. 

Potassium bromide, two drachms. 

Syrup, one-half ounce. 

Peppermint water, one and one-half ounces. 
A teaspoonful every hour or two. 

^ No. 58. 

Castor oil, two drachms. 

Pulv. acacia, two drachms. 

White sugar, two drachms. 

Tincture opium, twenty-one minims. 

Cinnamon water, to make four ounces. 
A teaspoonful every two or three hours. 

couc. 

ty No. 59. 

Aromatic syrup rhubarb, one ounce. 
Tinct. cardamomi compound, one ounce. 
Paregoric, one ounce. 
Cinnamon water, one ounce. 
Two to four teaspoonfuls. 

^ No. 60. 

Magnesia carbonate, forty-five grains. 

White sugar, one and one-half drachms. 

Tinct. asafetida, one and one-half drachms. 

Tinct. opium, one-half drachm. 

Water, one and one-half ounces. 
Five to sixty drops, according to age. In infantile colic. 

I£ No. 61. 

Tinct. opium, twelve drops. 
Magnesia calcinate, twelve to twenty- four grains. 
White sugar, one drachm. 
Anise water, one and one-half ounces. 
Shake well. One teaspoonful to a child one year old. 



MEDICAL AND SURGICAL EMERGENCIES. 295 

^ No. 62. 

Tinct. valerian, two and one-half drachms. 

Spirits ether, one drachm. 

Peppermint water, four and one-half ounces. 

Syrup orange, one and one-half ounces. 
Take half wineglassful. For an adult. 

RENAL CALCULI OR GRAVEL. 

^ No. 63. 

Diluted nitric acid, three drachms. 

Diluted hydrochloric acid, three drachms. 

Syrup orange peel, one ounce. 

Distilled water, to make one pint. 
A wineglassful three or four times daily. 

If No. 64. 

Ammonia benzoate, two to three drachms. 
Syrup, one and one-half ounces. 
Water, six ounces. 
A tablespoonful two or three times daily. 

^ No. 65. 

Strychnine, one grain. 

Diluted nitric acid, one drachm. 

Water, twelve ounces. 
Two tablespoonfuls three times daily. 

BILIARY CALCULI OR GALL STONES. 

If No. 66. 

Ether, three drachms. 

Oil turpentine, two drachms. 
A half teaspoonful on sugar every day, in the morning, gradu- 
ally increased to one teaspoonful and continued until about a 
pound is taken. 

1^ No. 67. 

Olive oil, one pint. 
To be taken in divided doses before breakfast. 



296 MEDICAL AND SURGICAL EMERGENCIES. 

^ No. 68. 

Soda bicarbonate, five drachms. 
Divide into twenty powders. One powder three times daily 
for several months. 

^ No. 69. 

Chloroform, two drachms. 

Oil cinnamon, eight drops. 

Spirits camphor, one and one-half drachms. 

Tinct. opium, one and one-half drachms. 

Spirits wine, three drachms. 
Five to thirty drops in sweetened water every hour or two. 

^ No. 70. 

Soda phosphate, one-half ounce. 
Divide into twelve powders. One before each meal, continued 
for months. 

^ No. 71. 

Magnesia carbonate, one drachm. 

Borax, two drachms. 

Citric acid, two drachms. 

Boiling water, eight ounces. 
A tablespoonful three or four times daily. 

I£ No. J2. 

Liquid potassse, two drachms. 

Infusi. buchu, eight ounces. 
Three tablespoonfuls an hour after meals. 

TONICS. 

5 No - 73- 
Quinine sulphate, thirty grains. 

Diluted sulphuric acid, to make solution. 

Water, two ounces. 

Tincture iron, one-half ounce. 

Spirits chloroform, six drachms. 

Glycerine, four ounces. 

A teaspoonful three times daily. 



MEDICAL AND SURGICAL EMERGENCIES. 297 

If No. 74. 

Iron and ammonia citrate, thirty-two grains. 
Ammonia chloride, thirty-two grains. 
Syrup, two ounces. 
Anise water, two ounces. 
A teaspoonful three times daily. 

If No. 75. 

Spirits chloroform, five drachms. 

Dil. hydrochloric acid, two and one-half drachms. 

Inf. cinchona, fifteen ounces. 
Two tablespoonfuls three times daily. 

If No. 76. 

Tinct. iron chloride. 
Syrup, one ounce. 
Cinnamon water, two ounces. 
A teaspoonful three times daily. 

If No. yy. 

Infusi. cocae sacch., fify drachms. 

Glycerine, five drachms. 

Ext. cinchona fM., seventy-five minims. 

Tinct. canella, one drachm. 

Tinct. vanilla, forty-five minims. 

Tinct. cascarilla, one-half drachm. 
A tablespoonful three times daily. 

DIARRHEA, CHILDREN. 

If No. 78. 

Pulv. ipecac, one-half grain. 
Pulv. rhubarb, two grains. 
Soda bicarbonate, twelve grains. 
Divide into twelve powders. One powder every four to six 
hours to an infant one year old. In indigestion with acidity. 

If No. 79. 

Tinct. opium, sixteen drops. 
Bismuth subnitrate, two drachms. 



298 MEDICAL AND SURGICAL EMERGENCIES. 

Syrup, one-half ounce. 
Chalk mixture, one and one-half ounces. 
Shake well and give one teaspoonful every three or four hours, 
to a child one year old. 

If No. 80. 

Salol, six grains. 
Divide into twelve powders. A powder dry on tongue, followed 
by a sip of water, every two hours, to a child of six months. 

If No. 8i. 

Magnesia sulphate, one drachm. 
Tinct. rhubarb, one drachm. 
Syrup ginger, one drachm. 
Aquae carui, nine drachms. 
A teaspoonful three times daily to child one year old. 

^ No. 82. 

Soda bromide, one-half drachm. 

Mucilage acacia, one ounce. . - - 

Water, one ounce. 
A teaspoonful every three hours for child less than one year 
old. 



DIARRHEA, ADUI/TS. 

^ No. 83. 

Paregoric, one-half ounce. 
Spirits ether compound, one-half-ounce. 
Ext. valerian fid., one-half ounce. 
Oil peppermint, thirty drops. 
Spirits lavender co., to make four ounces. 
A teaspoonful every two or three hours. 

^ No. 84. 

Morphine sulphate, one-half grain. 
Hydrarg. chlorid. mit., one grain. 
Pulv. camphorse, one scruple. 
Mucil. acacia, to form mass. 
Divide into twelve pills. A pill every two hours. 



MEDICAL AND SURGICAL EMERGENCIES. 299 

ty No. 85. 

Ext. hematoxyli, one-half drachm. 

Tinct. opium, two minims. 

Water, two ounces. 
A dessertspoonful three or four times daily. 

^ No. 86. 

Tannic acid, fifteen grains. 
Ext. krameria, one-half drachm. 
Syrup, to form mass. 
Divide into twenty pills. One to ten pills daily. 

5 No. 87. 

Prepared chalk, two drachms. 
Tinct. catechu, one-half ounce. 
Tinct. opium, eighty minims. 
Cinnamon water, eight ounces. 
Two tablespoon fuls after each motion. 

^ No. 88. 

Tannic acid, thirty-six grains. 

Pulv. opium, four grains. 
Divide into twelve pills. One pill every three or four hours. 

^ No. 89. 

Aquae camphorse, three ounces. 
Spts. lavend. co., one ounce. 
Sacch. albi., one drachm. 
A tablespoonful every two hours. 

DROPSY. 

^ No. 90. 

Vini colchici. sem., one-half ounce. 

Liq. ammonii acetat., two and one-half ounces. 

Infusi petroselini, five ounces. 

Teaspoonful every four hours. Especially adapted to scarletinal 
dropsy. 



3 oo MEDICAL AND SURGICAL EMERGENCIES. 

^ No. 91. 

Spirits chloroform, twenty minims. 
Tinct. digitalis, ten minims. 
Infusion buchu, one ounce. 
To be taken three or four times daily and followed by a good 
drink of water. In renal dropsy. 

^ No. 92. 

Potassium bicarbonate, ten grains. 
Iron and ammonia citrate, five grains. 
Tinct. digitalis, ten minims. 
Infusion buchu, one ounce. 
To be taken three times daily. In cardiac dropsy with gouty 
tendency or debility. 

9 No. 93. 

Pulv. digatilis, thirty grains. 
Iron sulphate exsiccat., fifteen grains. 
Pulv. capsicum, forty grains. 
Pil. aloe and myrrh, two drachms. 
Make sixty pills. One pill twice daily. In cardiac dropsy 
with flatulent dyspepsia and constipation. 

DYSMEN0RRH0EA ( PAINFUL MENSTRUATION). 

^ No. 94. 

Potassium bromide, four drachms. 
Chloral hydrate, four drachms. 
Syrup, two ounces. 
Water, two ounces. 
Two tablespoonfuls to be used as an enema, as required, for 
pain. 

5 No - 95- 

Antipyrin, two drachms. 

Syrup tolu, two ounces. 
Two teaspoonfuls at first; one teaspoonful every hour or two 
afterward until pain is relieved. 



MEDICAL AND SURGICAL EMERGENCIES. 301 

If No. 96. 

Tinct. Pulsatilla root, one-half ounce. 
Two or three drops every two hours for ten days preceding the 
period. 

If No. 97. 

Liq. ammonia acetat., four ounces. 
A tablespoonful every two or three hours with the following : 

Pulv. ipecac, four grains. 
Make twelve pills. One every two or three hours. 

DYSPEPSIA. 

If No. 98. 

Soda sulpho-carbolate, four drachms. 
Glycerine, two ounces. 
Infusion quassia, six ounces. 
A tablespoonful before meals. In flatulent dyspepsia. 

If No. 99. 

Bismuth subnitrate, four scruples. 
Mucilage acacia, one ounce. 
Soda bicarbonate, four scruples. 
Infusion columbo, eight ounces. 
Two tablespoonfuls before meals. Irritative dyspepsia with 
malnutrition and raw tongue. 

^ No. 100. 
Tinct. capsicum, sixteen minims. 
Tinct. nux vomica, two drachms. 
Tinct. gentian compound, two ounces. 
A teaspoonful in water three times daily, with grain 1-5 aloin at 
l)ed-time, avoiding starchy diet. For aggravated dyspepsia with 
constipation. 

IJ No. 101. 
Bismuth subnitrate, one drachm. 
Soda bicarb., one drachm. 



302 MEDICAL AND SURGICAL EMERGENCIES. 

Pulv. cubebs, one drachm. 
Pulv. ginger, one scruple. 
Make twelve powders. A powder in wineglassf ul water before 
each meal. 

^ No. 102. 
Tinct. opium, twelve drops. 

Magnesia calcinate, twelve to twenty-four grains. 
White sugar, one drachm. 
Anise water, one and one-half ounces. 
Shake bottle. One teaspoonful every two hours to a child one 
year old until relieved. If much pain add a little chloroform or 
Hoffman's Anodyne to the mixture. 

INFLAMMATION OF THE BOWELS. 

3J No. 103. 

Tinct. opium, one ounce. 
Ten drops every second or third hour, according to age, to the 
point of tolerance. 

I£ No. 104. 
Liq. potassii arsenitis, fifty drops. 
Tinct. opium, one hundred twenty drops. 
Water, three ounces. 
A teaspoonful before meals three times a day. In chronic form 
especially when malarial. 

^ No. 105. 

Castor oil, one drachm. 

Pulv. acacia, one and one-half scruples. 

White sugar, one and one-half scruples. 

Tinct. opium, three minims. 

Cinnamon water, eleven drachms. 
A teaspoonful every four hours for a child of one year. 

IJ No. 106. 
Pulv. opium, five grains. 
Bismuth subnitrate, two drachms. 
Make twenty powders. A powder every two to four hours for 
child of five. 



MEDICAL AND SURGICAL EMERGENCIES. 303 

EPILEPSY. 

If No. 107. 
Potassium bromide, one ounce. 
Ammonia bromide, one ounce. 
Ergot, fid. ext., one-half ounce. 
Water, to make four ounces. 
One teaspoonful, thrice daily. When maniacal excitement 
follows the attack, or cerebral congestion or hemorrhage if 
feared. 

If No. 108. 

Iron bromide, four grains. 

Potassium bromide, one ounce. 

Syrup, six ounces. 

Water, eight ounces. 
A teaspoonful twice daily. For anemic patients. 

^ No. 109. 

Ext. conii fid. (Squibbs), two ounces. 
Fifteen to sixty drops, not over three times a day. 

IJ No. no. 

Nickel bromide, sixteen grains. 
Distilled water, two ounces. 
A teaspoonful several times daily, according to tolerance. 

If No. in. 

Acetanilid (antifebrine), one drachm. 
Spts. vini gallici, one ounce. 
Syrup, two and one-half ounces. 
A teaspoonful two or three times daily. 

CARBUNCLE. 

If No. 112. 
Resorcin, one drachm. 
Lanolin, one ounce. 
Ointment. Apply after making multiple, parallel incisions into 
carbuncle. 



304 MEDICAL AND SURGICAL EMERGENCIES. 

If No. 113. 

Calcium sulphide, three grains. 

Ext. licorice, to make a mass. 
Divide into thirty pills. One pill every hour or two. 

^ No. 114. 

Tinct. muriate iron, one ounce. 

Potassium chlorate, one drachm. 

Glycerine, one ounce. 

Water, four ounces. 
A teaspoonful in a wineglassful of w^ter every two hours. 

^ No. 115. 
Nitrate of silver, four scruples. 
Distilled water, four drachms. 
To be applied two or three times on the inflamed surface, and 
beyond it on the healthy skin, to the extent of two or three inches. 

^ No. 116. 

Linseed meal. 

Boiling water. 
Make poultice. Apply hot as bearable, cover with oil-silk, and 
renew when cool or dry at edges. 

CHIIvBIvAINS. 

The following prescriptions to be applied externally. 

I£ No. 117. 

Carbolic acid, ten grains. 

Cosmoline, one ounce. 

Oil turpentine, one ounce. 
Apply to affected part. 

^ No. 118. 

Chloroform linament, two ounces. 
Apply with gentle friction. 

If No. 119. 

Tinct. iodine, one ounce. 
Apply with brush. 



MEDICAL AND SURGICAL EMERGENCIES. 305 

SELECTED PRESCRIPTIONS. 

Acute Nasal Catarrh. 

Carbolic acid, eight minims. 

Ichthyol, one drachm. 

Dilute alcohol, two and one-half drachms. 

Distilled water enough to make three ounces. 
Use as a spray, by means of atomizer, two or three times a day. 

Bromoform Emulsion. 

Bromoform, one-half drachm. 
Tolu tincture, one drachm. 
Acacia mucilage, two drachms. 
Syrup, four drachms. 

Spearmint water enough to make two ounces. 
Place the mucilage in a bottle, and add an equal volume of 
syrup, then add the bromoform and tolu tincture in portions, 
shaking well after each addition. A thin emulsion results, to which 
the rest of the syrup and the mint-water are to be added with 
agitation. 

Take a teaspoonful four times a day. 

Expectorant. 

Tar oil, fifteen minims. 

Horehound extract, one-half drachm. 

Anise oil, one minim. 

Whisky, one ounce. 

Clarified honey enough to make two ounces. 
One-half to one teaspoonful several times a day. 

Influenza. 

Quinine salicylate, three grains. 

Phenacetin, two and one-fourth grains. 

Camphor, two to five grains. 
Six of such doses in twenty-four hours. 

Cough Syrup — Prize Formula. 
Codein, one hundred grains. 
Benzoic acid, two drachms. 
20 



306 MEDICAL AND SURGICAL EMERGENCIES. 

Chloroform, five drachms. 

Peppermint oil, one drachm. 

Fl. ext. ipecac, six and one-half drachms. 

Fl. ext. tolu, three ounces. 

Fl. ext. licorice, one and one-half ounces. 

Fl. ext. wild cherry, two and one-half ounces. 

Glycerine, two ounces. 

Tar water, saturated, fifteen ounces. 

Alcohol, twenty ounces. 

Distilled water, two and one-half pints. 

Sugar, four pounds. 

Caramel, q. s. 
Dissolve benzoic acid and oil in alcohol, and mix with other 
ingredients except the sugar, chloroform and codein, and let stand 
twenty- four hours ; filter and dissolve codein and chloroform in 
filtrate which pass through a percolator containing the sugar, and 
add water sufficient to make one gallon. 
Take dessertspoonful every three hours. 

Flatulence. 

Creosote, ten minims. 

Bismuth subcarbonate, two drachms. 

Glycerine, one ounce. 

Peppermint water, one ounce. 
One teaspoonful every three or four hours; or 

Saccharin, one drachm. 

Pulv. wood charcoal, two drachms. 

Bismuth subnitrate, two drachms. 
Divide into twelve powders. One powder to be taken half an 
hour before each meal. 

Family Liniment — Prize Formula. 
Camphor spirit, one ounce. 
Opium tincture, one ounce. 
Chloroform, four drachms. 
Ammonia spirit, four drachms. 
Peppermint spirit, four drachms. 
Capsicum tinct., four drachms. 



MEDICAL AND SURGICAL EMERGENCIES. 307 

Sassafras oil, four drachms. 
Alcohol enough to make thirty-two ounces. 
For use externally as liniment. 

Diabetes Mellitus. (Sugar in urine.) 

Dried eucalyptus flowers, four drachms. 

Water, six ounces. 
Make an infusion. One such draught to be taken twice daily. 

Shampoo Jelly. 

White castile soap, four ounces. 
Hot water, sixteen ounces. 
Glycerine, four ounces. 
Lavender oil. 
Bergamot oil. 

Massage Cream. 

White wax, one-half ounce. 

Spermaceti, one-half ounce. 

Cocoanut oil, one ounce. 

Lanolin, one ounce. 

Oil of sweet almonds, two ounces. 
Melt in a porcelain dish, remove from the fire and add : 

Orange-flower water, one ounce. 

Tincture of benzoin, three drops. 

Mumps. 

Sulphate of magnesia, four drachms. 
Water, four ounces. 

Antimony and potassium tartrate, one grain. 
Sweet spirits of nitre, three drachms. 
Sugar, six drachms. 
A teaspoonful every three hours, after the bowels have been 
well moved. With flaxseed poultices locally. 

The following formulas are given as being practically the same 
as those contained in the so-called patent or secret formulas having 
an extensive sale : 



308 MEDICAL AND SURGICAL EMERGENCIES. 

Allen's Lung Balsam. 

Blood root, tincture of, two ounces. 
Lobelia, tincture of, two ounces. 
Opium, tincture of, one ounce. 
Capsicum, tincture of, three drachms. 
Sassafras, essence of, two drachms. 
Anise, essence of, two drachms. 
New Orleans molasses, one pint. 
Bring the syrup to a boil, add slowly the other ingredients and 
mix. 

Ayer's Cherry Pectoral. 

Acetate morphine, three grains. 

Bloodroot, tincture of, two drachms. 

Antimony, wine of, three drachms. 

Ipecac, wine of, three drachms. 

Wild cherry, syrup of, three ounces. 
Mix together. 

Ayer's Hair Vigor. 

Lead, sugar of, three drachms. 
Sulphur, flour of, two drachms. 
Glycerine, fourteen drachms. 
Water, five pints. 

Ayer's Sarsaparilla. 

Sarsaparilla, fid. ext. of, three ounces. 

Stillingia, fid. ext. of, three ounces. 

Yellow dock, fid. ext. of, two ounces. 

Mayapple, fld. ext. of, two ounces. 

Sugar, one ounce. 

Potash, iodide of, ninety grains. 

Iron, iodide of, ten grains. 
Mix together. 

Parke-Davis' Uterine Tonic. 
Each pill contains : 
Viburnum prunifolium, one grain. 
Viburnum opulus, one grain. 
Star grass, one-half grain. 



MEDICAL AND SURGICAL EMERGENCIES. 309 

Helonias, one-half grain. 

Squaw vine, one-half grain. 

Caulophyllum, one-quarter grain. 
Take one three or four times a day whenever there is head- 
ache, backache, and a dull pain and feeling of weight in the pelvic 
organs. 

Warner's Safe Kidney and Liver Cure. 

Lycopus virgin (the herb), extract of, three hundred and 
eight grains. 

Hepatica, extract of, two hundred thirty-two grains. 

Wintergreen, extract of, seven and one-half grains. 

Saltpetre, thirty-nine grains. 

Alcohol, two and one-half grains. 

Glycerine, ten drachms. 

Water sufficient to make one pint. 
Mix all together, and let stand for one week. Filter if neces- 
sary. 

Winslow's Soothing Syrup. 

Morphine, sulphate of, one-half grain. 
Soda, carbonate of, one grain. 
Simple syrup, one and one-half ounces. 
Pure water, one-half ounce. 
Fennel, spirits of, one drachm. 

Syrup of Figs. 

Senna leaves, one and three-quarter ounces. 

Coriander seed, six drachms. 

Figs, three ounces. 

Tamarind, two ounces. 

Cinnamon bark, two ounces. 

Prunes, one and one-half ounces. 

Licorice, extract of, one and one-half drachms. 

Peppermint, essence of, one and one-half drachms. 

Simple syrup, one pint. 

Thompson's Eye Water. 

Zinc, sulphate of, five grains. 

Copper, sulphate of, one and one-quarter grains. 



310 MEDICAL AND SURGICAL EMERGENCIES. 

Saffron, tincture of, one-half drachm. 
Camphor, tincture of, fifteen drops. 
Rosewater, two ounces. 
Pure water, two ounces. 
Mix together and filter through filtering paper kept by drug- 
gists. 

Buckley's Uterine Tonic. 
Each pill contains : 
Helonin, one-sixth grain. 
Caulophyllum, one-sixth grain. 
Macrotin, one-sixth grain. 

Hyoscyamin amorphus, one-two-hundred-fiftieth grain. 
Take one pill every three hours, or four times a day. If the 
throat becomes dry, or the face flushed, it is evidence that the 
dose should be lessened. If these symptoms do not appear, the 
amount can be increased if desired. 

This prescription gives most satisfactory results, and has been 
used by many noted physicians. 

Beecham's Pills. 

Saffron, one grain. 

Sodium, sulphate of, one grain. 

Rhubarb, four grains. 

Aloes, twenty grains. 
Mix, and make into three-grain pills. 

Boscheen's German Syrup. 

Tar, oil of, one drachm. 

Ipecac, fluid extract of, one-half ounce. 

Wild cherry, fluid extract of, six drachms. 

Opium, tincture of, four drachms. 

Magnesia, carbonate of, three drachms. 

Water, six ounces. 

White sugar, ten ounces. 
Mix the magnesia first with the oil of tar, add the fluid ex- 
tracts, mix thoroughly, then add the tincture of opium and water. 
Filter and form a solution with the sugar by shaking the bottle. 



MEDICAL AND SURGICAL EMERGENCIES. 311 

Brandreth's Pills. 

Aloes, four ounces. 

Colocynth, extract of, four drachms. 

Gamboge, two ounces. 

Castile soap, one ounce. 

Oil of peppermint, twenty drops. 

Cinnamon, seven drops. 
Mix and form into pills. 

Brown's Bronchial Troches. 

Licorice, extract of, pulverized, one pound. 

Sugar, pulverized, one and one-half pounds. 

Cubebs, pulverized, four ounces. 

Gum arabic, pulverized, four ounces. 

Conium, extract of, pulverized, one ounce. 
Mix. 

Bucklen's Arnica Salve. 

Arnica, extract of, one ounce. 

Resin cerate, eight ounces. 

Vaseline, two ounces. 

Seedless raisins, eight ounces. 

Fine-cut tobacco, one-half ounce. 

Water, a sufficient quantity. 
Boil the raisins and tobacco in one pint of water until the 
strength is extracted, press out the liquid and evaporate to four 
ounces. Soften the extract of arnica with a little hot water and 
mix the liquid with it. Add this to the cerate and vaseline, pre- 
viously warmed, and mix all thoroughly. 

Bull's Cough Syrup. 

Morphine, sulphate of, three-fourths grain. 

Granulated sugar, two drachms. 

Syrup, three ounces. 
Mix together. 

Carter's Little Liver Pills. 

Podophyllin, two and a half grains. 



312 MEDICAL AND SURGICAL EMERGENCIES. 

Ground aloes, three grains. 

Gum arabic, mucilage of, enough to make a soft mass. 
Divide into twelve pills and coat with sugar. Take at bed-time 
one or more as needed. 

Castoria. 

Senna, four drachms. 

Manna, one ounce. 

Rochelle salts, one ounce. 

Fennel seed, bruised, one and a half drachms. 

Boiling water, eight ounces. 

Sugar, eight ounces. 

Oil of wintergreen, enough to flavor. 
Pour the water on the ingredients. Cover and macerate until 
cool. Strain; add sugar and oil of wintergreen. 

Cuticura Ointment. 

The much advertised Cuticura Ointment has been found to 
consist of a base of petroleum jelly, colored green, perfumed with 
oil of bergamot and containing two per cent, of carbolic acid, or 
nine drops to the ounce. 

Cuticura Resolvent. 

Aloes socot., one drachm. 

Rhubarb, powdered, one drachm. 

Iodide potassium, thirty-six grains. 

Whisky, one pint. 
Macerate over night and filter. 

Davis' (Perry) Pain Killer. 

Guaiacum, powdered, two and one-half ounces. 

Camphor, two drachms. 

Cayenne pepper, powdered, six drachms. 

Caustic liquor of ammonia, one drachm. 

Opium, powdered, one-half drachm. 
Digest these ingredients in one quart of alcohol for two weeks 
and filter. 

Fellow's Hypophosphites. 

Glucose (grape sugar), one pound. 



MEDICAL AND SURGICAL EMERGENCIES. 313 

Lemon, syrup of, one pint. 

Calcium, hypophosphites of, one hundred twenty-eight 
grains. 

Potash, hypophosphites of, forty-eight grains. 

Iron, sulphate of, forty-eight grains. 

Magnesia, sulphate of, thirty-two grains. 

Strychnine, sulphate of, two grains. 

Quinine, sulphate of, fourteen grains. 
Dissolve the calcium and potassium hypophosphites in two 
ounces warm water. Add to one ounce water, three ounces syrup ; 
dissolve in mixture by aid of heat, the sulphates. Mix the solu- 
tions and set by a few hours covered. Filter into bottle contain- 
ing remainder of syrup, wash the residue with an ounce of boil- 
ing water and mix filtrate and washings with the syrup. Dis- 
solve the glucose in the mixture and add through the filter enough 
water to make two pints. 

Green Mountain Salve. 

Resin, ten ounces. 

Burgundy pitch, four drachms. 

Beeswax, four drachms. 

Mutton tallow, four drachms. 

Oil hemlock, one drachm. 

Balsam fir, one drachm. 

Oil origanum, one drachm. 

Oil red cedar, one drachm. 

Venice turpentine, one drachm. 

Oil wormwood, one-half drachm. 

Verdigris, powdered, one drachm. 
Melt the first articles together and add the oils. Rub up the 
verdigris with a little oil, put it in with the other articles, stir 
well, and then put the basin containing the mixture into a larger 
vessel of cold water, and work with the hands until cold enough 
to roll. 

Greene's Nervura. 

Cinchona, tincture of, five ounces. 

Damiana, tincture of, five ounces. 

Cocoa, tincture of, five ounces. 
Mix. 



3 i4 MEDICAL AND SURGICAL EMERGENCIES. 

Green's August Flower. 

Rhubarb, three hundred sixty grains. 

Golden seal, ninety grains. 

Cape aloes, sixteen grains. 

Peppermint leaves, one hundred twenty grains. 

Potash, carbonate of, one hundred twenty grains. 

Capsicum, five grains. 

Sugar, five ounces. 

Alcohol, three ounces. 

Water, ten ounces. 

Peppermint, essence of, twenty drops. 
Powder the drugs and macerate in- the mixed alcohol and water 
for seven days; filter, and add enough diluted alcohol to make 
the whole measure one pint. 

Haarlem Oil. 

Sulphur, two ounces. 
Linseed oil, one pound. 
Amber, oil of, two ounces. 
Boil the sulphur and linseed oil on a slow fire until the sulphur 
is dissolved. When somewhat cooled take the oil of amber and 
enough oil of turpentine to bring the preparation to the con- 
sistence of molasses. 

Hop Bitters. 

Hops, tincture of, one-half ounce. 

Buchu, tincture of, three drachms. 

Senega, tincture of, three drachms. 

Podophyllin (dissolved in spirits of wine), ten grains. 

Cochineal, tincture of, twenty drops. 

Distilled water sufficient to make one pint. Mix. 

Hostetter's Bitters. 
Sugar, one ounce. 
Sweet flag root, one ounce. 
Orange peel, one ounce. 
Peruvian bark, one ounce. 
Gentian root, one ounce. 
Columbo root, one ounce. 
Rhubarb, two drachms. 



MEDICAL AND SURGICAL EMERGENCIES. 315 

Cinnamon, one drachm. 
Cloves, one-half drachm. 
Diluted alcohol, one pint. 

Hunyadi Janos Water. 

Lime, sulphate of, seventy-two grains. 

Glauber salts, two and one-half ounces. 

Epsom salts, two and one-half ounces. 

Potash, sulphate of, six grains. 

Water, eight pints. 
Mix together and charge with gas if desired. Dose, one-half 
glassful more or less. This is an active cathartic. 

Liebig's Corn Cure. 

Indian hemp, extract of, five drachms. 

Salicylic acid, four ounces. 

Collodion, one-half ounce. 
Mix until dissolved. Apply with camel hair brush four con- 
secutive nights and mornings. 

Lydia Pinkham's Vegetable Compound. 

Cramp bark, four ounces. 

Partridge berry vine, four ounces. 

Poplar bark, two ounces. 

Unicorn root, two ounces. 

Cassia, two ounces. 

Beth root, one and one-half ounces. 

Sugar, one and one-half pounds. 

Alcohol, one pint. 

Water a sufficient quantity. 
The drugs should all be reduced to a moderately coarse pow- 
der. Pour on boiling water, let stand until cold, then percolate 
with water until the percolate measures one pint; add the sugar, 
bring to a boil. When cold add the alcohol and strain. 
One or two teaspoonfuls three or four times a day. 

Orange Blossom. 

Zinc, sulphate of, one drachm. 

Alum, fifteen grains. 

Cocoa butter, three drachms. 



316 MEDICAL AND SURGICAL EMERGENCIES. 

White wax, one-half drachm. 

Sweet almonds, oil of, one and one-half drachms. 

Henbane, extract of, one grain. 

Paine's Celery Compound. 

Celery seed, two ounces. 

Red cinchona, one ounce. 

Orange peel, one-quarter ounce. 

Coriander seed, one-quarter ounce. 

Lemon peel, one-quarter ounce. 

Hydrochloric acid, fifteen drops. 

Alcohol, five ounces. 
v Glycerine, three ounces. 

Water, four ounces. 

Syrup, four ounces. 
Grind the solids to moderately coarse powder (No. 40), mix 
the acid and water, add glycerine and alcohol, and in the men- 
struum so prepared macerate the powder for twenty-four hours. 
Then percolate, adding enough water and alcohol in the propor- 
tion to make twelve fluid ounces. Finally add the syrup and if 
necessary, filter. 

Peruna. 

Copaiba, six drachms. 
Cubebs, two drachms. 
Calisaya bark, ground, two ounces. 
Stone root (collinsonia), ground, two ounces. 
Corydalis (Turkey corn), ground, two ounces. 
Deodorized alcohol, one pint. 
Add all the ingredients to the alcohol. Let stand one week. 
Shake the bottle frequently, finally strain or filter. 

Pettit's Eye Salve. 

Olive oil, four drachms. 
Spermaceti, one and one-half drachms. 
White wax, one-half drachm. 
Melt together and add gradually in a warm mortar the follow- 
ing in fine powder and thoroughly mix, stirring briskly while 
adding : 



MEDICAL AND SURGICAL EMERGENCIES. 317 

Zinc, oxide of, thirty grains. 
White precipitate, twenty grains. 
Benzoic acid, two grains. 
Morphine, sulphate of, three-quarter grain. 
Rosemary, oil of, one-half grain. 
Stir until cool and keep in a well-covered vessel. 

Pierce's Favorite Prescription. 

Savin, one hundred fifty grains. 

Cinchona, one hundred fifty grains. 

Agaric, seventy-five grains. 

Cinnamon, seventy-five grains. 

Water sufficient to make eight ounces. 
To this add the following : 

Acacia, one hundred fifty grains. 

Sugar, seventy-five grains. 

Digitalis, tincture of, one-half drachm. 

Opium, one-half drachm. 

Anise, oil of, eight drops. 
Dissolve the gum and sugar in the strained decoction and add : 

Alcohol (in which the oil has previously been dissolved), 
two ounces. 

Pierce's Golden Medical Discovery. 

Cinchona, fluid extract of, sixteen ounces. 
Columbo, fluid extract of, four ounces. 
Guaiac, fluid extract of, eight ounces. 
Licorice, fluid extract of, four ounces. 
Opium, tincture of, one ounce. 

Podophyllin (resinoid), one hundred twenty grains. 
Glycerine, six pints. 

Alcohol enough to dissolve the podophyllin. 
Mix all together. One teaspoon ful from two to four times a 
<lay. 

Pimple Lotion. 

Carbolic acid, one drachm. 
Borax, four drachms. 
Glycerine, two ounces. 



318 MEDICAL AND SURGICAL EMERGENCIES. 

Tannin, two drachms. 
Alcohol, three ounces. 
Rosewater, ten ounces. 
Mix and dissolve. Apply night and morning. 

Pink Pills For Pale People. 

Iron, sulphate of, one-half ounce. 
Potash, carbonate of, one hundred forty ounces. 
Sugar, forty-eight ounces. 
Tragacanth in fine powder, sixteen ounces. 
Glycerine, ten drops. 
Water enough to make a mass. Mix and divide into one hun- 
dred fifty pills. 

Radway's Ready Relief. 

Soap liniment, one and one-half ounces. 
Capsicum, tincture of, one-half ounce. 
Ammonia, water of, one-half ounce. 
Alcohol, one-half ounce. 

Sage's Catarrh Remedy. 
Golden seal, powdered, one ounce. 
Borax, powdered, ten grains. 
Common salt, ten grains. 
Cyanuret of iron, sufficient to color. 

Seidlitz Powders. 

Rochelle salts, two drachms. 
Soda, bicarbonate of, two scruples. 
Tartaric acid, thirty-five grains. 
Mix the salts and soda together and put in a blue paper; put 
the tartaric acid in a white paper. When using, put the powder 
contained in the blue paper in about half a glass of water, then 
add the tartaric acid and drink quickly while effervescing. 

Seven Barks. 

Hydrangea, extract of, one drachm. 

Poke root, extract of one and one-half ounces. 

Culver's root, extract of, one and one-half ounces. 



MEDICAL AND SURGICAL EMERGENCIES. 319 

Dandelion, extract of, one and one-half ounces. 

Ladies' slipper, extract of, one and one-half ounces. 

Colocynth, extract of, one and one-half ounces. 

Bloodroot, extract of, six drachms. 

Blue flag, extract of, six drachms. 

Stone root, extract of, six and three-quarter drachms. 

Golden seal, extract of, seven and one-half drachms. 

Mandrake, extract of, three ounces. 

Black cohosh, extract of, three ounces. 

Butternut, extract of, six ounces. 

Spirits of sea salt, two ounces. 

Aloes, ten drachms. 

Borate of sodium, two ounces. 

Capsicum, infusion of, four and one-half drachms. 

Sassafras, powdered, eleven drachms. 

Ginger, six drachms. 

Syrup, one and one-quarter quarts. 

Water, sufficient to make three quarts. 

Shiloh's Consumption Cure. 

Morphine, muriate of, three grains. 

Muriatic acid, three drops. 

Henbane, fluid extract of, two drachms. 

Ginger, fluid extract of, three drachms. 

Wild cherry, fluid extract of, three drachms. 

Alcohol, one and one-half drachms. 

Water, one and one-half drachms. 

Chloroform, one drachm. 

Peppermint, essence of, one-half teaspoonful. 

Tar, syrup of, three ounces. 

Syrup, enough to make eight ounces. 

Sozodont. 

Castile soap, seventy-five grains. 

Glycerine, seventy-five grains. 

Alcohol, one ounce. 

Water, five drachms. 

Peppermint, oil of, sufficient quantity. 

Cloves, oil of, sufficient quantity. 



320 MEDICAL AND SURGICAL EMERGENCIES. 

Anise, oil of, sufficient quantity. 
Cinnamon, oil of, sufficient quantity. 

Squibb's Diarrhea Mixture. 

Opium, tincture of, one ounce. 

Capsicum, tincture of, one ounce. 

Camphor, spirits of, one ounce. 

Chloroform, purified, one hundred eighty drops< 

Alcohol, enough to make five ounces. 
From fifteen to thirty drops. 

St. Jacob's Oil. 

Gum camphor, one-quarter ounce. 
Chloral hydrate, one-quarter ounce. 
Chloroform, one-quarter ounce. 
Sulphuric ether, one-quarter ounce. 
Opium, tincture of, one drachm. 
Origanum, oil of, one drachm. 
Sassafras, oil of, one drachm. 
Alcohol, one pint. 

Stuart's Dyspepsia Tablets. 

Each tablet contains the following: 
Common baking soda, ten grains. 
Morphine, one-twentieth grain. 

Swift's Syphilitic Specific. 

Old man's gray beard root, one peck. 

Prickly ash root, four ounces. 

White sumac root, two ounces. 

Red sumac root, two ounces. 

Sarsaparilla root, one and one-half ounce. 

Copper, sulphate of, two drachms. 
Bruise the gray beard and sumac roots and put them with the 
sarsaparilla into an iron pot sufficient to hold eight gallons of 
water, or cover the roots completely with water. Cover the pot 
with pine tops and boil slowly until the liquid assumes the color 
of ink. Strain while warm, add the sulphate of copper and good 
Holland gin sufficient to prevent fermentation. Dose, one wine- 
glassful four times a day. 



PREGNANCY. 

The First Things to Do — Diet — Breasts and Nipples — The 
Teeth — Exercise — Rest — Bathing — General Health — 
Clothing — Miscarriages — Preparation for Labor — The 
Obstetrical Nurse — Useful Suggestions for the Nurse — 
Suggestions for Nurse During Labor — Maternity Outfit, 
Necessities For — Child-Bed Fever — Antiseptic Powders — 
Rules for Emergencies Among Children — Artificial 
Feeding — Diet for Lying-In Period. 

the first things to do. 

As soon as she is aware of her condition, or has a belief as to 
its probability, the mother should place herself under the care 
of an experienced physician, as a certain degree of professional 
advice and attention is required during the whole period of preg- 
nancy. While the condition as a rule is merely weakness, the 
borderland between health and disease may very easily be over- 
passed. At any time disorders or complications may occur, these 
in all probability can be warded off or promptly remedied by the 
physician's watchful care and treatment. The mother's whole 
duty now is to herself and her child. Nothing should be per- 
mitted to interfere with the well-being of either. Some of the 
symptoms of pregnancy are suppression of the menses, darkening 
of the brown area (areola) surrounding the nipples, and morn- 
ing sickness, sometimes accompanied by nausea and vomiting at 
different periods of the day. 

There is generally an inability of the bladder and later a secre- 
tion of milk-like fluids in the breasts with an enlargement of the 
same and an enlargement of the abdomen. Upon the appearance 
■of any or all of these symptoms a physician should be consulted. 

Pregnancy is liable to occur at any time during the inter-men- 
21 321 



322 MEDICAL AND SURGICAL EMERGENCIES. 

strual periods. The full term of pregnancy is 280 days. This 
may be prolonged to more than 300 days. The embryo is fully 
developed at the end of nine calendar months. Its expulsion is 
termed labor, confinement or parturition. The period covered by 
this expulsion is known as the puerperium. The period following 
delivery and until recovery is called the lying-in period. To cal- 
culate the date when confinement will take place count back three 
months from the date of the close of the last menstruation and 
add to this seven days. For example, the date of the last menstru- 
ation was May 1 ; substract three months, February 1 ; add seven 
days, will give February 8, as the probable date of delivery. The 
movements of the child, spoken of as "life," begin at from four to 
four and one-half months. The sensation has been described as 
resembling the fluttering of a bird in a closed hand. These move- 
ments should cause no anxiety. If painful and annoying the 
mother should avoid active exercise and seek rest ; if they persist 
she should consult her physician. 

During the period of pregnancy a woman is often inclined to 
be irritable and despondent. For the sake of both her child and 
herself she must try to overcome this tendency. Her husband 
and friends should try to make her home life calm and happy, and 
should shield her so far as possible from all disturbing influences. 
"Thousands of children are, by unpleasant impressions on the 
mother's mind, rendered the victims of untruthfulness and dis- 
obedience, together with malicious, threatening and even murder- 
ous natures." 

A child is most liable to be affected physically during the earlier 
months ; mentally, during the latter months of pregnancy. 

A mother should not read medical books, except by consent of 
her physician, nor horror stories, nor anything that will tend to 
morbid thoughts. Everything of an emotional or disagreeable 
nature should be avoided. Late hours or excitement of all kinds 
should be eschewed. Despondency is sometimes caused by physi- 
cal conditions which can be relieved by the physician. 

DIET. 

It is the popular opinion among women during this period that 
they require more than their usual quantity of food. This is a 
mistake that often leads to much suffering. A healthy woman 



MEDICAL AND SURGICAL EMERGENCIES. 323 

will not and ought not to require, in the earlier months especially, 
more than the usual amount of food. Craving for and surfeiting 
with unusual articles of food, proceeds from a disorganized sys- 
tem and may be avoided by a little attention. Many authorities 
might be cited to show that the abuse of diet at this time, in the 
way of over-eating, or partaking of indigestible foods, is the 
occasion of dyspepsia and stomach disorders, which can in this 
way be transmitted from parent to child. 

No absolute rule can be laid down, as the same foods do not 
agree with all patients, but in a general way the following may 
be accepted : 

Food should be plain, nutritious, easily digestible ; it should be 
taken at regular intervals. Morbid cravings must be repressed, 
but individual fancies, dislikes or idiosyncracies may be indulged, 
provided the food chosen fulfills the above requirements. Over- 
eating, especially in the later months, should be guarded against. 
At this time, when there is little space for a full stomach, the 
meals may be small, but more frequent. Tea, which constipates, 
and coffee should be taken with great moderation. No alcoholic 
drinks should be taken except by the advice of a physician. Milk 
and chocolate are unobjectionable. The one drink most impor- 
tant to every function of the body is pure water ; this should 
always be taken in sufficient quantity. Cereals are useful, with 
fruits, at breakfast, to keep the bowels open. 

The following is a list, showing in a general way what foods 
may be taken and what should be avoided. The pregnant patient 
may take: 

Soups. Clear soups of all kinds, animal broths, chicken broth, 
pea puree, oyster broth and clam broth. 

Fish. Fresh fish of all kinds, of salt fish codfish only is permis- 
sible ; oysters, clams. 

Meats. Mutton, lamb, beef, tender pig, pork, bacon, chicken, 
game, tongue, sweetbreads, turkey, goose (both better eaten 
cold). 

Eggs in every form; cream, butter. 

Cereal breakfast foods (except oatmeal), corn, graham and 
wheat muffins, graham, whole wheat and white bread, soda or 
baking powder biscuits, pancakes (except buckwheat), rice and 
macaroni and mush. 



3 2 4 MEDICAL AND SURGICAL EMERGENCIES. 

Vegetables. Green uncooked cabbage, cauliflower, lettuce, 
spinach, dandelion, spring onions, corn, squash, cucumbers, 
radishes, horseradish, peas, celery, tomatoes, plain vegetable 
salads, melons, potatoes sparingly. 

Fruits. Fresh and cooked fruits of all kinds except bananas ; 
home canned and dried fruits ; nuts, except chestnuts and peanuts. 

Puddings, etc. Fruit pies of all kinds, pumpkin, squash and 
custard pies and gelatine puddings, cornmeal pudding, blanc 
mange, whipped cream, ice cream, honey, maple syrup, plain cake. 

Beverages. Half a glass of water one-half hour before each 
meal and upon retiring ; coffee for breakfast only ; cocoa, malted 
milk, grain coffee, cold tea, lemonade, ginger ale, mineral water. 
Stimulants only when ordered by physician. 

To be avoided. Soups made from vegetables growing under 
ground, salt pork with or without beans, baked beans, boiled 
dinners, ham, veal, duck, liver, kidneys, hash, meat-mixed salads, 
corned beef, canned meats or fish, canned soups, mackerel, dried 
salt meats or fish, except codfish. Tapioca, oatmeal, sugar on 
breakfast cereals, bananas, skins of fruit, mince pies, suet pud- 
dings, layer cakes, fruit cake. 

BREASTS AND NIPPIES. 

For a couple of months before labor the nipples should be 
washed daily with pure soap and water and afterwards carefully 
dried and anointed with fresh cocoa butter or white vaseline. The 
same treatment also will do more to prevent sore, cracked nipples 
during nursing, by keeping them supple, than the method of 
hardening them with astringents. During the last months the 
breasts should be massaged quite freely, as this will make the milk 
flow more freely on the first days, at which time it is usually slow. 
The physician should examine the breasts in the early stages of 
pregnancy to ascertain whether the nipples can be drawn out early 
and any cracks and fissures, soreness or sensitivenes should be 
reported to the physician. 

THE TEETH. 

"For every child a tooth," says an old proverb; because the 
saliva is more acid during pregnancy, and the teeth if neglected 



MEDICAL AND SURGICAL EMERGENCIES. 



?2^ 



decay more rapidly. An alkaline mouth wash should be frequently 
used, one-half teaspoonful baking soda in a glass of water. It is 
a fact that the teeth are apt to undergo destructive changes if 
special care is not taken. 

EXERCISE. 

Even up to the very day of lying-in, a healthy pregnant woman 
will find herself benefited by exercise. Extremely active exercise 
should be avoided. Exercise should be in the open air if possible ; 
nothing is better than walking. Horseback riding and bicycling 
or even carriage riding over rough roads are apt to be harmful. 

Light housework is beneficial but heavy lifting and all muscular 
strain must be carefully avoided. Never allow undue exposure to 
cold and dampness. Wet feet will often cause death of the child 
and place the mother in a dangerous condition. If the feet are in- 
clined to be cold let them be rubbed briskly with a rough towel. 

REST. 

An abundance of sleep is necessary; at least eight hours every 
night should be taken, and a short nap during the day may well be 
added. The usual marital relations are distasteful to most women 
during this period, and to many are the source of much pelvic dis- 
comfort, as well as a prominent factor in aggravating the nausea 
and sickness of the early months and in causing abortion. There- 
fore it is well during the first months of pregnancy and again at 
the close (especially in women with a known tendency to abor- 
tion), that the husband and wife occupy different beds. 

BATHING. 

The functions of the skin are to be kept active at all times 
during pregnancy, but more especially toward the close, to relieve 
the kidneys as much as possible. On rising a cold sponge bath is 
refreshing. Cold baths, however, should be carefully used ; a tepid 
bath, especially a sitz bath, once every day, and perhaps a hot bath 
every other day are beneficial. The hot bath should be taken at 
night to avoid taking cold. For the sitz bath an ordinary tub may 
be used. The water should cover hip and pelvis well. This bath 



326 MEDICAL AND SURGICAL EMERGENCIES. 

should be of just four minutes duration and may be taken just 
before retiring or before mid-day and followed by an hour's rest. 
During the last half of pregnancy a daily application of cocoanut 
oil, vaseline or pure sweet oil will relieve irritation or cracking of 
the skin. After bathjng, cold cream should be applied to the lower 
vaginal soft parts. Vaginal douches should not be taken except by 
the advice of a physician. To apply a vaginal douche properly 
use a fountain syringe. Use water that has been boiled and cooled, 
have the water 112 to 118 degrees Fahrenheit. From ten to twenty 
drops of carbolic acid may be added to a quart of water. Hang the 
syringe not over four feet above the level of the body. Sit either 
in a bath tub or else over a slop jar or a bed-pan in a half lying 
down position, use from one to four quarts of water. 

GENERAL HEAI/TH. 

The better a woman's health and strength during her pregnancy, 
the better will she be able to pass through the ordeal of labor and 
perform the duties of motherhood. Most women pay too little 
attention to themselves. Any deviation from ordinary good health 
should be reported at once, especially if any of the following symp- 
toms are present: excessive vomiting, loss of appetite, varicose 
veins, hemorrhage, constipation or diarrhea, sleeplessness, severe 
or continued headache, disturbances of sight, such as dimness of 
vision or the appearance of spots floating before the eyes, fainting, 
swelling of the face, hands or feet, and any diminution of the 
amount of urine passed. 

CLOTHING. 

Outer garments should fit loosely and comfortably ; if suspended 
around the waist they should be as light as consistent with comfort 
and health and heavy garments should hang from the shoulders, 
which is the best method, as it does not bring too much weight 
upon the vital organs. No undue pressure should be made by the 
clothing upon the chest or abdomen ; ordinary corsets must there- 
fore be discarded, but a waist or broad abdominal band may be 
worn, if by its support it gives comfort. Skeleton corsets to sup- 
port the breasts may be worn when required, but they should not 
squeeze the waist. Underwear should be of wool, of thickness 



MEDICAL AND SURGICAL EMERGENCIES. 327 

suited to the season. Tight garters impeding the circulation must 
not be worn. High-heeled shoes which impede locomotion and 
cause stumbling are not to be worn. 

MISCARRIAGES. 

Miscarriages are more apt to occur in women who have borne 
children. They generally occur at the third or seventh months. 
They usually follow violent exercise, extreme fatigue, a long 
journey, accidents, severe illness or attempts at abortion. 

If at any time during pregnancy the mother is affected with 
chills, nervousness, faintings, pain in the pelvis, a sensation of 
weight about the hips and back, discharge accompanied with blood, 
she should remain in bed and summon a physician. After such 
symptoms subside she should avoid any work or exercise which is 
fatiguing. 

THE PREPARATION EOR LABOR. 

About two weeks before delivery, symptoms of approaching 
labor manifest themselves acutely. These last until after the child 
descends into the pelvis, after which a sense of relief is experi- 
enced. Even when this is accompanied by diarrhea, a frequent 
desire to urinate or even a discharge, there need be no alarm. 
Slight pains may also be experienced several days before actual 
labor sets in. 

Everything should be in readiness two or three weeks before 
confinement and the physician and nurse consulted. The nurse 
should know where everything is, so that- at the time of labor con- 
fusion may be avoided. For the lying-in room, a large well- 
ventilated room, with a sunny exposure, should be selected. As 
labor may occur at night a good artificial light should be provided. 
The room should not be exposed to contamination from defective 
plumbing or other sources of impurity. A room with a stationary 
washstand or sink is preferable. Under no conditions should a 
room be selected if it has recently been occupied by a patient suf- 
fering from a suppurating wound, cancer, erysipelas or any con- 
tagious or infectious disease ; nor should anything that has been 
used by such patient, as furniture, mattresses, pillows, etc., be 
admitted to the lying-in room. Thorough cleanliness is the matter 



328 MEDICAL AND SURGICAL EMERGENCIES. 

of chief importance and this can be attended to even in the most 
humble home. Any defective plumbing should be repaired, drains 
flushed and disinfected and in case an infectious disease has 
occurred in the house, have it thoroughly disinfected. This clean- 
ing and disinfection should be attended to about a week before 
labor is expected to occur and the room be kept clean. Unnecessary 
curtains, hangings, bric-a-brac and furniture should be removed, 
though not so completely that the room will not be left comfortable 
and cheerful. There should be available an abundant supply of 
hot water. A gas or oil stove in the room is a great convenience. 

As soon as labor pains begin the physician should be summoned. 
While awaiting his arrival the patient should receive an enema 
consisting of a pint of warm soap suds to which a teaspoonful of 
spirits of turpentine has been added. This may be repeated if the 
first stage of labor is very prolonged. The use of the water-closet 
is prohibited during this period. If labor is prolonged or brings 
great suffering, and if advised by the physician, four grains of 
sulphate of quinine can be taken every two hours. A warm bath, 
preferably a sitz bath, is then to be taken and the patient dressed. 
The management of the case is now entirely in the physician's 
hands. 

The following has been suggested by a lady physician as a suit- 
able attire in confinement : An undervest, a long nightdress, a pair 
of large, roomy open drawers, a skirt made -extra large, a pair of 
stockings, a pair of bedroom slippers and a wrapper. A large 
sanitary napkin or towel is also worn for protecting the underwear. 

It is advisable to have ready a complete change of underwear 
and extra sheets for use if necessary. Have ready also a plentiful 
supply of hot water and some water which has been boiled and 
cooled. The latter should be kept well covered from dust and dirt. 

THE OBSTETRICAL NURSE. 

The obstetrical nurse fills a very trying position, and to be suc- 
cessful, must be especially adapted to her chosen calling. She has 
two patients under her care, and many demands are made upon her 
time, strength and good nature, both by day and night. Conse- 
quently she must be cheerful and obliging as well as neat, trust- 
worthy and entirely truthful. Above all else she must be 



MEDICAL AND SURGICAL EMERGENCIES. 329 

thoroughly in accord with the physician, obeying his orders to the 
last degree, and reporting to him at once any infractions of the 
rules that he has laid down for the patient. Bright, intelligent 
women between the ages of twenty-eight and thirty-five years 
make the best obstetrical nurses. Old women and so-called 
monthly nurses are worse than useless. 

The nurse, like the physician, must be scrupulously neat and 
cleanly in her habits and instincts. When in attendance on a case 
she should wear a dress of wash goods, made with detachable 
sleeves which can be taken off when she has any duties to perform 
about the patient. An apron must always be worn and a nurse's 
cap is very desirable. A nurse should be careful to provide herself 
with enough clean caps, dresses and aprons to provide against any 
emergency. A bed or cot should be provided for her in the lying-in 
room, but she should under no circumstances sleep with the 
patient. 

If possible, her work should be so arranged that she can be out 
of doors in the fresh air for an hour every day, and the thoughtful 
physician will see that this opportunity is given her." 

USEFUL SUGGESTIONS TO THE NURSE. 

The proper temperature for the lying-in room is 68 to 70 
degrees Fahr., both day and night. 

No medicine or vaginal douches should be given without specific 
order from the physician. Notify the physician at once of any 
important occurrence. 

Visitors should not be allowed in a lying-in chamber for two or 
three weeks after confinement, except with the consent of the 
physician. Take the temperature, with fever thermometer, and 
pulse of mother every four hours for first week ; afterward night 
and morning. Report immediately to physician if the pulse is over 
100 or temperature over 100.5. The special need of the mother is 
complete rest in bed for ten or twelve days. She should not walk 
about the room for four or five days after that and should not 
leave the room or lift her child until full three weeks after con- 
finement. For one month she should not read or sew. She should 
be given a sponge bath daily. 

Absolute cleanliness (asepsis) of the person, the clothing and 



330 MEDICAL AND SURGICAL EMERGENCIES. 

bedding of the patient is of vital importance. No cloth or article 
should touch the genitals of the patient or navel of the child, 
unless first made sterile. If not supplied from sterile packages 
(as in maternity outfits), cloths and bandages should be dipped in 
antiseptic solution, camphenol, or solution of antiseptic soap, then 
washed by boiling water, ironed, wrapped in sheets and if possible 
baked in an oven for an hour. These should be kept covered until 
used. 

All soiled cloths and clothing should be removed from the room 
at once and steeped in an antiseptic solution ; solution camphenol 
one tablespoonful to one quart of water. Burn cloths, which can 
not be used again. Change sanitary pads every four hours during 
the first week. Bathe external genitals every four hours, when 
the patient is awake, with a warm antiseptic solution. Use ab- 
sorbent cotton or gauze for this purpose. Wash the genitals after 
urination with boiled water. Do not use a catheter without in- 
structions. 

The best position for the mother is lying on the back. She may 
be moved from one side of the bed to the other several times a 
day. Keep a pad of gauze cloth filled with absorbent cotton or a 
folded clean sheet under patient, and change when it is soiled. 

The nipples should be wiped off before and after using, with a 
solution of boric acid. Swollen and painful breasts should be 
given gentle massage. Oil the hands before rubbing. An in- 
flamed breast should not be rubbed. Any extreme sensitiveness 
should be reported to the physician. 

BATHING. 

The first bath after birth can be delayed for some hours where 
the child has been anointed with olive oil and wrapped in a woolen 
blanket. The first bath should be with castile soap suds at a 
temperature of ioo degrees F. (use a thermometer), and should 
be given in a warm room, preferably in front of a fire, only uncover- 
ing a portion of the body at a time. The nurse should wear a 
water-proof apron and over it a flannel apron or blanket. Two 
different cloths or sponges should be used for the head and body. 
The head and face should be washed in separate water. The 
scalp should be cleansed thoroughly. The eyes should never be 



MEDICAL AND SURGICAL EMERGENCIES. 331 

washed with a wash cloth, but should be cleaned with a piece of 
gauze or lint wet with a solution of boric acid or by dropping 
water that has been boiled and cooled. 

SUGGESTIONS FOR NURSE DURING LABOR. 

The following suggestions are easy to carry out and 
will be found useful to those who have not had the advantage of 
obstetric training. One direction of great importance will bear 
repetition. The lying-in room must be kept well ventilated and 
clean. Soiled linen should be removed as soon as possible and 
should be immediately immersed in water preparatory to washing. 

There are three stages of labor. The first is from the beginning 
of the labor pains to the rupture of the bag of waters ; it may be 
of several hours duration. The second stage is from the time of 
the rupture of the bag of waters until the delivery of the child; 
this may vary from fifteen minutes to three hours. The third 
stage is from the birth of the child until the delivery of the after- 
birth. 

The position to be assumed by the patient in the successive 
stages of labor is a matter of importance. During the first stage 
she may walk or sit with an occasional rest in bed. In lying down 
it is best to lie upon the left side with the head and shoulders 
raised. 

If labor occurs at night the nurse should see that the patient 
gets some sleep. If necessary she should consult the physician. 
Sleeping drugs or stimulants should not be given except on the 
physician's orders. Above all, meddlesome visitors should not 
be admitted at this stage, nor should conversation be allowed 
upon severe or remarkable cases of child-birth. The patient must 
be kept in a cheerful, hopeful frame of mind. During this first 
stage everything which can possibly be needed for the physician 
and patient should be placed at hand ready for instant use. During 
the second stage the physician should surely be present. The 
patient may lie on the left side or back according to comfort, and 
according to the instructions of the physician. 

At the very commencement the obstetrical outfit should be 
opened and contents laid out on a clean sheet. Dishes, pitchers 
and bowls should be cleansed in boiling water and a sterile cloth 



332 MEDICAL AND SURGICAL EMERGENCIES. 

laid over them. Instruments, scissors, etc., should be boiled and 
wrapped in sterile gauze. The nurse should sterilize her hands 
and after such sterilization should not allow them to come in con- 
tact with any unsterile object, such as bed clothing, furniture, or 
utensils. Some nurses draw a pair of sterile cotton or rubber 
gloves over their hands after sterilization and remove them when 
necessary, rinsing their hands in sterile water after the removal 
and before touching the patient. 

It is a good plan to train the hands so as always to use the same 
one for touching unsterile objects. One hand is thus kept abso- 
lutely sterile for touching the patient. Every sponge or cloth 
should be thrown in a slop jar as soon as used, forceps being em- 
ployed to prevent contact with the fingers. If the towel or cloth on 
which the patient lies becomes soiled with the feces it must be 
covered at once with a fresh towel wet with an antiseptic solution, 
a bichloride solution made with the tablets for that purpose. 

Chloroform is generally used to lighten the pains of labor. 
There need be no fear of the results where its use is advised by a 
competent physician. Patients should understand that in these 
cases chloroform is not given to the point of complete anaesthesia 
as is the case in surgical operations. Before chlorofrom is used 
the patient's face should be coated with vaseline as a protection 
against the irritating action of the drug. The discovery of the' 
efficacy and safety of chloroform in this use has been one of the 
blessings of modern science. 

As soon as the head of the child is born the mouth should be 
cleared of blood and mucus with a piece of gauze dipped in a 
solution of boric acid, made by dissolving ten grains of boric acid 
in eight teaspoon fuls of water. The eyes should be cleansed with 
water without soap or else with the boric acid solution. 

After the delivery of the child the first step is to tie and cut the 
cord. When sterilized tape for this purpose is not at hand use a 
piece of white silk cord that has been thoroughly boiled in water. 
The child as soon as born should be received into a warm woolen 
blanket. The body of the child is to be anointed with olive oil. 

The end of the cord is to be cleaned, dried, and wrapped with a 
square of the lintine dipped in alcohol or borated solution and held 
in place by a soft bandage. The third or final stage of labor is 
the removal of the after-birth. It is best accomplished with the 



MEDICAL AND SURGICAL EMERGENCIES. 333 

patient on her back, from which position she should not be 
changed for at least ten hours. The after-birth should be burned. 



A COMPLETE MATERNITY OUTFIT. 

This outfit is put up according to the suggestion of Dr. Joseph 
Brown Cooke, of New York; it will be found to contain all the 
articles which the most exacting practitioner could require. It 
contains : 

Six abdominal binders, each nine by fifty-four inches. 

Twenty-four sanitary (vulva) pads, made of absorbent cotton 
covered with bleached gauze, sterilized and wrapped. For- ab- 
sorbing discharges. 

Two obstetrical sheets, blankets of gauze and cotton for pro- 
tecting bedding. 

Two quarter pound packages absorbent cotton, for compresses 
or pads. 

Two papers safety pins. 

One nail brush. 

Twelve squares lintine, for cleansing the infant's eyes and 
mouth. 

Alcohol, for dressing cord and for bathing purposes. 

Synol soap, for disinfecting and lubricating hands and instru- 
ments. 

Olive oil, for anointing infant immediately after birth before it 
is bathed. 

Saturated solution boric acid, sterile, for cleansing the infant's 
eyes and mouth immediately after the birth of the head, and after- 
ward for bathing the nipples and washing the baby's mouth before 
and after nursing. 

Vaseline, in collapsible tubes, sterile, for lubrication and in- 
unction. 

Castile soap. 

One bottle antiseptic tablets (bichloride), for making antiseptic 
solutions. 

Two sponges, soft, different sizes, sterilized. For the infant. 

This outfit is put up by Johnson & Johnson, New Brunswick, 
N. J., and may be procured through any druggist. 



334 MEDICAL AND SURGICAL EMERGENCIES. 

NECESSITIES FOR THE MATERNITY OUTFIT. 

These outfits should be kept sealed and closed until the time of 
labor, then let the nurse or physician open them. This caution is 
important and may be the means of avoiding disastrous results. 
In addition there should be kept ready in the room the following 
articles : 

Two or three small tables for holding basins, instruments, etc. 

One piece of rubber sheeting, i-jxij yards. 

One piece white enamel cloth, i^xij yards. 

One slop jar or pail, absolutely clean. 

Two agate wash basins. 

Six flannel binders. 

One dozen clean towels made up in a parcel and covered. Old 
soft ones without fringe are the best. 

Diapers, slips and other clothing for the baby. 

As far as possible, a supply of clean sheets, pillow cases, night 
gowns and towels. In families where an abundance of sheets and 
rubber or oil cloth is not to be had, large pads of newspapers or of 
heavy wrapping paper may be used. Pads may be made by sewing 
the paper to cloths, first boiling and cleaning the cloths, and pads 
so made are far preferable to soiled quilts or blankets. 

For the infant's first toilet there should be provided a thick 
woolen blanket, cotton diapers, a wool slip petticoat, a cotton slip 
overgarment, some extra blankets. Any other articles may be 
supplied as the physician directs or the need suggests itself. The 
following list of articles necessary for the proper clothing of an 
infant has been found useful: Six nightgowns, six woolen petti- 
coats, six woolen slips, one-half dozen woolen socks, six woolen 
bands, six long-sleeved woolen shirts, diapers, one dozen muslin 
slips. In addition there should be provided safety pins, bathing 
aprons of soft flannel, an infant's hair brush and a powder puff. 

CHII.D-BKD FKVKR. 

Child-bed fever has been called the scourge of the lying-in room. 
It is caused by poisons produced by germs or microbes gaining an 
entrance to the genital tract. These germs may be carried to the 
patient by attendants who are not clean. The germs of child-bed 



MEDICAL AND SURGICAL EMERGENCIES. 335 

fever are found upon dusty or dirty carpets, floors and walls of 
rooms, soiled clothing, vessels, utensils and instruments that have 
not been made surgically clean, that is sterilized. Sponges, old 
unwashed cloths and unboiled water are often filled with them. 

Privies, cesspools, defective drains and garbage barrels often 
help in the dissemination of the germs of child-bed fever through 
the air. It has been found that child-bed fever can only be en- 
tirely avoided by the absolute cleanliness known to the surgeons 
as a condition of asepsis, free from poison. The successful 
physician now requires that the lying-in room shall be as clean as 
the hospital operating room. The best practitioners insist that 
physician, nurse and all who come in contact with the patient go 
to the room only after a thorough bathing and putting on of clean 
attire. That the patient, before she enters the lying-in bed, shall 
receive a thorough bath and put on clothing that is absolutely 
clean. That the hands, instruments and clothing that are to come 
in contact with the patient's body, are to be sterilized. It is of the 
greatest importance that all articles used in or about the mother 
and child at the time of child-birth should be in a condition that 
is termed surgically clean — this is the superlative degree of clean- 
liness. The dressings in the Simpson or Cooke maternity outfits 
are surgically clean — sheets, towels, etc. If necessary to use 
cloths, other than those contained in the maternity outfits, they 
must be carefully prepared and made ready, whether new or old. 
They should be washed, dried, etc., ironed and wrapped in a sheet 
or pillow case. Those which are to be used as wiping cloths, pads, 
towels, or used on the mother as dressings, should be put into an 
oven and baked for as long a time as may be convenient. 

The dressings contained in the Cooke or Simpson outfits, or 
those which may be prepared as above described, should not be 
opened or handled except by the physician or nurse at the moment 
of use. 

ANTISEPTIC POWDERS IN THE SICK-ROOM. 

As soon as the new-born child has been washed, the skin should 
be dusted, especially in the folds and crevices, with some suitable 
antiseptic baby powder. At least once a day, and after each time 
the infant is bathed, the skin should be dusted in this way with the 
powder on a soft feather puff. This will prevent chafing and the 



336 MEDICAL AND SURGICAL EMERGENCIES. 

soreness so likely upon the tender skin. Around the face and 
mouth, where the baby is apt to moisten the skin frequently with 
saliva, the powder should be applied very often. Its absorbing 
and emollient action will prevent chafing. 

For the mother. The skin should be dusted over with antiseptic 
baby powder each time it is washed. This is very important where, 
as on the thighs, the skin may be several times wet with poisonous 
discharges. An application of the powder after each washing 
of the skin is preferable to hard rubbing with a towel. It secures 
absolute dryness without the abrading and chafing entailed by the 
hard rubbing. Where washing must be frequent as in maternity 
cases, this is an important point. Antiseptic powder is an almost 
indispensible article in cases of child-birth. At least, it contributes 
so largely to comfort that it has come to be considered as such. 

In the period of nursing the nipples frequently become sore; 
in such case they should be rubbed with cold cream or vaseline 
and then thoroughly dusted with the baby powder. 

RULES FOR EMERGENCIES AMONG CHILDREN. 

If the child is suddenly attacked with vomiting, purging and 
prostration, send for a doctor at once. In the meantime put the 
child for a few minutes in a hot bath, then carefully wipe it dry 
with a warm towel, and wrap it in warm blankets. If its hands 
and feet are cold, bottles filled with hot water and wrapped in 
flannel should be laid against them. 

A mush poultice or one made of flaxseed meal, to which one- 
quarter part mustard flour has been added, or flannels wrung out 
of hot vinegar and water, should be placed over the abdomen. 

Five drops of brandy in a teaspoonful of water may be given 
every ten or fifteen minutes ; but if the vomiting persists, give 
brandy, milk and lime water in the same quantity. 

If the diarrhea has just begun or if it is caused by improper 
food, a teaspoonful of castor oil, or of spiced syrup of rhubarb, 
should be given. If the child has been fed partly on the breast 
and partly on other food, the mother's milk alone must now be 
used. If the child has been weaned, it should have its milk food 
diluted with lime water or should have weak beef-tea or chicken- 
water. 



MEDICAL AND SURGICAL EMERGENCIES. 337 

The child should be allowed to drink cold water freely. 

The soiled diapers or the discharges should be at once removed 
from the room, but saved for the physician to examine at his next 
visit. • 

ARTIFICIAL FEEDING. 

Feeding is by far the most important part of the care of a baby. 
Life itself depends upon the food. At birth the stomach holds 
about one ounce, or two tablespoonfuls, and is so easily distended 
that much more than this can be crowded into it by overfeeding, 
to the great discomfort and injury of the child. 

A baby naturally feels hungry and thirsty at times from the 
first, and may also sometimes suffer pain. It has only one way of 
making these troubles known and that is crying. Too often this 
crying is hushed by a nursing or a feeding, when perhaps the little 
sufferer is not hungry at all, and the wail proceeds from an en- 
tirely different cause. Too frequent or too liberal feeding distends 
the stomach to twice or thrice its natural size, the baby is uncom- 
fortable and cries or vomits in self-defense, because there is no 
room in the stomach for the liquid that has been poured into it. 

The overplus may irritate the bowels and give rise to diarrhea. 
A bottle-fed baby should be fed : 

One week, every two hours, one ounce or two tablespoonfuls. 

Two to four weeks, every two hours, one and one-half ounces or 
three tablespoonfuls. 

One to three months, every two and one-half hours, three and 
one-half ounces or seven tablespoonfuls. 

Three to six months, every two and one-half hours, four and 
one-half ounces or nine tablespoonfuls. 

Six to twelve months, every three hours, seven and one-fourth 
ounces or fourteen and one-half tablespoonfuls. 

Twelve to eighteen months, every three hours, nine ounces or 
eighteen tablespoonfuls. 

No matter how much food is put into the child's stomach it is 
nourished only by the amount which is digested. The extra quan- 
tity does harm instead of good, causing pain, vomiting, colic and 
diarrhea. More infants die from too much food than from too 
little. Some mothers, either naturally or because of ill-health, 
22 



338 MEDICAL AND SURGICAL EMERGENCIES 

secrete milk which is not fit for food. When the child does not 
thrive artificial food should be tried. 

DIET FOR LYING-IN PERIOD. 

First day : Coffee, with cream, toast, a saucer of some favorite 
cereal with cream, a cup of hot milk or of gruel. 

Second day : Coffee with cream, cocoa, toast, a cup of hot milk, 
gruel, oysters or clam broth, a cup of tea with crackers, toast 
sticks with butter, cream or milk toast. 

Third day : The same as for the second day with the addition of 
baked or stewed apple. If the milk comes profusely on this day 
leave out liquids as much as possible. 

Fourth day: Soft boiled or poached egg, toast, coffee, plain 
soup or broth of chicken, veal or mutton, crackers, bread and 
butter, jelly, honey, orange juice, a cup of tea or cocoa, cooked 
fruit. 

Fifth day: Coffee or cocoa, broiled beefsteak or lamb chop. 

On the sixth day and thereafter, the patient may partake of her 
regular diet with the exception of the fibrous vegetables growing 
under ground, cooked cabbage, oatmeal, baked beans, boiled 
dinners, mixed salads, pickles and bananas. It is quite necessary 
during the period of nursing for the mother to partake regularly 
between meals, of some easily digested liquid food. 

In addition to my own experience, I am indebted for many 
valuable suggestions contained in the preceding article, to a very 
complete brochure published by Johnson & Johnson, New Bruns- 
wick, N. J. 



THE VALUE OF HYGIENE. 

It is interesting to note that the imperial health officers of Ber- 
lin, after long study of the subject, make the important declaration 
that hygiene is the great preventive of tuberculosis. Cleanliness 
and order, they hold, are the first requisites in the whole system 
of living. The body should be washed daily with moderately cold 
water, or it should be rubbed rapidly with a rough, wet towel. 
The hair, beard, teeth and mouth, as well as the nails, should be 
kept as clean as possible. 

BREATHING. 

Keep the mouth closed and breathe through the nose ; this is the 
natural filter for impurities and injurious matter. An employer 
should remove causes of injury to health of the persons employed, 
or limit them as much as possible (dust, smoke, etc.). Work- 
time and rest should be arranged in appropriate proportion. The 
luxurious classes in this country, clean in their own persons, live 
in a fools' paradise. Though they keep their own houses perfect 
in every way, as regards sanitation, and think because of this they 
are insuring themselves against attacks of disease, they are for- 
getting the fact that if disease is to be prevented it is imperative 
that they should see that the dwellings of their tenants, depend- 
ants and neighbors are equally sanitary. Every sensible person of 
every rank should endeavor to constantly urge with all his power 
the legislation to improve the dwellings of the poor, and to enforce 
with the utmost severity the existing sanitary laws, imperfect as 
they are. 

It would not be too much to say that three-fourths the deaths 
are due wholly to preventable causes, and that the average dura- 
tion of life might be extended to almost double what it is now. 



339 



340 MEDICAL AND SURGICAL EMERGENCIES. 



EXERCISE. 

Another important factor of individual concern is the value of 
exercise in the open air. Without this there can be no perfect 
health. It is as essential to supreme health as food and water are 
.to life. Exercise, by bringing the blood to the surface of the body 
and increasing its flow through the lungs*, subjects it to the puri- 
fying influence of fresh air. It is important, therefore, that any- 
one who wishes to attain sound health, should make it a point to 
take daily walks, accustoming himself to inclement weather, 
changing damp clothing and shoes. 

Go early to bed. Avoid excesses of every kind, as they destroy 
in a little time what it has taken long to attain. 

Finally, avoid intercourse with persons suffering from infectious 
disease; if duty or calling involve such intercourse, do not neglect 
the proper precautions. 



INFANTILE INDIGESTION. 

Dietetic Management and Miek Substitutes Eor Children. 

To the Medical Record of August 2, 1902, Fischer contributes 
a paper replete with practical suggestions. He tells us that the 
following substitutes have been of especial value to the writer, and 
are offered for temporary use in gastric and intestinal derange- 
ments : 

How to prepare barley water. This can best be made by tak- 
ing one heaping tablespoonful of ground barley flour and, adding 
the same to one pint of water. Boil this thoroughly for half an 
hour, then strain through cheese-cloth, and add enough water to 
make one pint of barley water. It is advisable to sweeten by add- 
ing one heaping teaspoonful of granulated sugar. When sugar is 
contraindicated, as in fermentative conditions, add saccharin. 
When barley water is given for any length of time, and constipa- 
tion results therefrom, then glycerin should be added. One tea- 
spoonful of glycerin to each teacup ful of barley water will make 
the same quite palatable, and will offset the constipating tendency. 

How to prepare oatmeal water. This can be made by adding 
one tablespoonful of oatmeal flour to a pint of water, boiling the 
same in the manner described in the preparation of barley water. 

If the child is underfed, then frequently the addition of the 
white of a raw egg, well beaten, with either of the above men- 
tioned barley water or oatmeal water, will be found advantageous. 
In like manner the writer has frequently added the yolk of an egg, 
well beaten, with barley water or oatmeal water properly sweet- 
ened, as a temporary substitute. 

Vegetable proteids. Great success is frequently scored by veg- 
etarians, especially by the use of the celebrated vegetable milks. 
When we consider the ingredients used, it is' no wonder that they 
offer good temporary, and often permanent, substitutes for ani- 
mal milks. The writer has frequently recommended the use of 

341 



342 MEDICAL AND SURGICAL EMERGENCIES. 

almond milk made by blanching almonds (sweet almonds) with 
scalding water and then rubbing them up thoroughly. One or 
two ounces of sweetened almonds with one pint of water will 
yield about one pint of almond milk. When it is to be used as the 
only substitute for milk the almonds can be thoroughly mashed 
and boiled with the water to extract all of the nutritive substance. 
This can best be done in the following manner : Scald about one 
to two ounces of sweetened almonds, removing the skin ; then add 
about eight ounces of fresh water and mash the almonds to a pulp ; 
boil this pulp with the water for about fifteen or twenty minutes, 
next strain through cheese-cloth, and add enough water to make 
one pint. Finally add one tablespoonful of granulated sugar. This 
can be given ad libitum, depending upon the age of the child to 
be fed. It is certainly a very nutritious substitute for milk con- 
taining proteid. 

The writer frequently uses this almond milk as a diluent to 
break up the curd in cow's milk instead of using cereal decoctions. 
When children have eczema and erythematous eruption following 
the use of cereals, then almond milk may be used with advantage 
to dilute cow's milk. It is useful as a food in urticaria. 

Vegetable soup substitutes. Mashed peas, boiled with beef or 
chicken or veal, offers a very nutritious proteid substitute for 
milk. This will be found especially advantageous during the hot 
summer months, when milk is not well borne, and when the physi- 
cian requires a nutritious food which can be fed in doses of two, 
three, four, six, or eight ounces at proper intervals, just exactly 
as milk would have been given. 

Tea as a substitute. Weakened mixed tea is frequently of 
great service with or without white of egg. When children have 
diarrhea and milk cannot be given, then dextrinized wheat or dex- 
trinized barley or dextrinized rice offers a convenient and valu- 
able substitute. 

Tea with barley water, coffee with barley water. Weak tea, 
mixed with equal parts of barley water, is very valuable as a tem- 
porary substitute in hot weather. It can be fed in teaspoonful 
doses. It should be made palatable by sweetening with granulated 
sugar. 

Coffee diluted with barley water or with rice water is very val- 



MEDICAL AND SURGICAL EMERGENCIES. 343 

liable as a substitute for milk when marked cardiac depression 
from continued diarrhea exists. 

A few points concerning milk. When cow's milk is to be used 
for infant feeding a simple test can be used with advantage by 
almost every one. It consists in dipping a piece of blue litmus 
paper into the milk when it is received. If the blue litmus turns 
red, then it shows that the milk is acid. Such milk is entirely un- 
fit for infant feeding, and it is necessary to add to such milk a 
pinch of either bicarbonate of sodium or bicarbonate of potassium. 
When acid milk is fed to children we will invariably have trouble. 

It is advisable to learn the source of the milk, so that we can 
know the age of the milk received. A good plan is to procure milk 
which has been milked on the day it is bought. Such milk can be 
procured in a great many dairies. Several of our largest labora- 
tories receive milk on the morning of the milking, and hence are in 
a position to supply fresh milk of a low bacteria count and before 
fermentation is developed. It is self-understood that the older 
the milk the more chance is offered to the development of micro- 
organisms and the greater the tendency to fermentation. It is 
stale milk that invariably causes gastroenteric disturbances. When 
fresh milk is procured, then the same may be safely fed in its raw 
state, after having been warmed to the proper feeding tempera- 
ture. 

When milk stands for several days, as it frequently does in New 
York city, then no amount of boiling, Pasteurizing, nor sterilizing 
can destroy the toxins developed by the colon bacillus. Such milk 
is a deadly poison. The experiments made by Prof. Victor 
Vaughan, of Ann Arbor, Mich., have shown that, no matter how 
much heat is applied to such milk, its toxins cannot be destroyed. 
This investigator subjected milk to a temperature of 300 F. with- 
out destroying this toxin. The toxin produced in milk is a deadly 
poison, and it is this toxin that is the cause of cholera infantum, 
which ends so fatally. It is advisable, therefore, to secure clean 
milk from a clean source, and to feed it in clean vessels, if we de- 
sire good results. 

If modern sanitary methods are applied in the stables, at the 
creamery, and, most important of all, at the home in which the 
milk is modified for infant feeding, then we have the remedy 



344 MEDICAL AND SURGICAL EMERGENCIES. 

against the development of summer complaint, as well as of scurvy 
and rickets, which sometimes are the stepping-stones to tubercu- 
losis in later year c 

FORMULA FOR WEAK INFANTS IN SUBSTITUTE FFFDING. 

When vomiting and diarrhea persist give either 

Barley water, 4 ounces, 

Or 

Oatmeal water, 4 ounces. 

Feed every two or three hours. Sweeten with granulated sugar, 
half-teaspoonful to each bottle. 

If fermentation exists — colic, greenish stools, and eructations — 
use saccharin, one-half grain, instead of sugar for sweetening. 

When constipation is caused by continued use of barley or rice 
water, then sweeten with glycerin by adding half-teaspoonful of 
pure glycerin to each four-ounce bottle of rice, oatmeal, or barley 
water. 

FORMULA FOR ALMOND MILK FOOD. 

Almond milk, 4 ounces. 
Granulated sugar, 1 teaspoonful. 
Mix. Feed above quantity every three hours. 

Whey. To make whey, take half a pint of fresh milk, heated 
lukewarm, not warmer than can agreeably be borne by the mouth 
(about 1 1 5 F.) ; add one teaspoonful essence of pepsin, and stir 
just enough to mix. Pour into custard cups; let it stand until 
firmly curdled ; then beat up with a fork until the curd is finely 
divided ; now strain, and the whey is ready for use. 

Whey prepared from fresh cow's milk should be alkaline and 
contain from : 

0.08 to 1 per cent of lactalbumin. 
0.03 per cent of casein. 
1.0 per cent of fat. 

When such whey is added to milk, take of whey two parts, milk 



MEDICAL AND SURGICAL EMERGENCIES. 345 

one part, for an infant under six weeks. This can be increased 
until equal parts of milk and whey are used. (To be used for a 
child several months old.) 

FORMULA FOR WHEY FEEDINGS 

For an infant under six months : 

Whey, 2 ounces. 
Milk, 1 ounce. 
Warm to blood temperature (about ioo° F.) for three minutes, 
then feed. 

Above quantity can be fed every two or two and one-half hours. 
When feeding a child two or four months old : 

Whey, 2 ounces. 
Milk, 2 ounces. 
Feed every three hours. 

If the above is well borne, we must gradually increase by adding 
an ounce of food ; the formula will then be : 

Whey, 2\ ounces. 
Milk, 2J ounces. 
Feed above quantity every three hours. 

The general condition of the infant — its sleep, its stool, and its 
body weight — is an important factor to determine an increase in 
the quantity of food. 

If the child cries very much after feeding and appears hungry, 
then we can give : 

Whey, 3 ounces. 
Milk, 3 ounces. 
Feed every three hours. 

Some children at three months will take very readily six ounces 
of food. If the appetite warrants it, and the stool is homogeneous 
and well digested, then we need not hesitate to give the following : 

Whey, 3 ounces. 
Milk, 4 ounces. 
Feed every three hours. 



346 MEDICAL AND SURGICAL EMERGENCIES. 

The weight is the determining factor. If the child does not 
thrive, increase the quantity of milk and decrease the whey. 

In the case of feeble and debilitated children the writer fre- 
quently orders sweetened whey instead of water for quenching 
thirst. This is especially valuable in summer. 



AIR AND WATER. 

Air and water are two remedies apt to be overlooked by the 
profession in the search for cures, yet as all progress is constantly 
bringing us back to, and accentuating the value of, first principles, 
we occasionally find cases on whom all medicines have lost effect, 
and who yet can be restored by the intelligent use of these two 
natural agencies. 

We have a case in mind at this writing. The patient had been 
an invalid for years. She had been the round of doctors and 
pathies. Had experimented with all the fads at home and abroad, 
with only temporary benefit. At length, she fell into the hands of 
a common-sense doctor in a little country town where she was 
passing the summer. 

He regulated her diet and established her habits on a sound hy- 
gienic basis. Then he taught her how to breathe (something 
which many people do not know), and insisted that she drop 
everything and devote a few minutes several times a day to proper 
breathing. Also, and most important of all, that she drink a glass 
of water every hour of the day while awake. 

She followed his directions to the letter, principally out of curi- 
osity at first, and later because she began to see the good effects 
of the treatment. Her color improved, flesh became firm and 
bowels regular. In six months she was perfectly well. 

The tissues of this woman were full of impurities, which the 
increased supply of oxygen and water either burned up or flushed 
out into the proper channels of elimination. The circulation and 
excretory organs felt the stimulus of the additional fluid and in- 
creased their work. When the auto-toxemia was relieved, all the 
unpleasant symptoms subsided. 

The good effects which follow a sojourn at the various mineral 
springs are due chiefly to the large amount of water drunk, and 
the moderate, but regular, amount of exercise involved in getting 
it. 

347 



URIC-ACID-PRODUCING FOODS. 

It is commonly believed that nitrogenous food is the main car- 
rier of uric acid into the body. This is in part confirmed by the 
presence of so large a quantity of normal uric acid in the urine of 
carniverous animals. The truth is that the uric acid is derived 
from the nucleo-proteids which much of the nitrogenous food con- 
tains. The so-called nucleins which contain xanthin, hypoxanthin, 
adenin and caffein are the ones most to blame for the formation of 
uric acid. The substances are combined with albumen in the nu- 
cleins, but they are uncombined in the "meat juices" — in the ex- 
tractives of animal tissues. These substances are not present to 
any great extent in milk, casein or in eggs, and not so much in the 
muscular structure of beefsteak as in the juices of the steak. 

Coffee, tea and cocoa are very active in producing uric acid. 
This substance has been increased more than one hundred and 
twenty-five per cent by drinking coffee alone. A diet of bread and 
butter, potatoes, milk and eggs, will yield a normal quantity of 
uric acid, which will be increased one and one-half times by the 
addition of fresh meat. I have observed frequently that dried beef 
can be eaten with impunity by "uric acid" patients, with no very 
great increase of uric acid, but with a great increase of strength. 
This is due to the partial exclusion of the juices by the drying 
process. 

Animal proteid alone is not productive of uric acid. Those sub- 
stances, then, most necessary to avoid when it is desirable to ex- 
clude uric acid are, meat extracts, meat juice, beef tea, liver, 
sweet-bread, juicy fresh meats and fish roe, as well as tea, coffee 
and cocoa. The digestion of those articles which are beneficial 
must be attended to with great care, as the proper performance of 
the digestion is of immense importance. 



348 



MASSAGE. 

An intelligent appreciation of the value of massage seems to be 
confined to a few physicians. A similar few make a fad of it, and 
by its promiscuous use, pervert its beneficial effects, and so tend 
to bring it into disrepute. Its true place as a therapeutic agent 
should be known to all, for there are cases in which it stands un- 
rivaled as a source of relief. 

In cases where the blood and secretions are thick, the circula- 
tion sluggish, the nerve centers torpid, sensibility deficient, the 
special senses blunted, massage is invaluable. Tissue metabolism 
and elimination are impaired in these cases, and the effect of mas- 
sage is to stimulate the cell changes which we call nutrition, and to 
improve the lymphatic and venous circulations, leading directly to 
improved excretion. 

Massage stimulates the medulla, or nerve of organic life, and 
hence exercises a beneficial influence over all the vital functions. 
It is particularly helpful in diseases of degeneration and devital- 
ized conditions. In the bilious and lymphatic temperaments, espe- 
cially where there is a tendency to obesity, massage will give you 
satisfactory results. Hysterical patients are benefited by massage 
if the reflexes are sluggish. Wherever you find cutaneous anes- 
thesia, a slow or deficient response of the reflexes, you will get 
good effects from massage. 

On the other hand, the nervous and sanguine temperaments, 
generally, are not benefited. Such patients are made worse by 
massage. They do not require stimulation of any kind. Massage 
exhausts them or intensifies the nervous condition. 

There are people who complain of chronic discomfort ; they 
never do anything much, yet are always tired. This fatigue is the 
result of a toxic condition of the blood. Massage rests such peo- 
ple. They experience a heavenly sense of peace and physical well- 
being afterward. It enable them to secure refreshing sleep and 
to eat with appetite. 

349 



VALUE OF COUNTER-IRRITATION. 

The benefit to be derived from counter-irritation is one of the 
things we do not want to overlook in our pursuit of novelty. Es- 
pecially is it useful in respiratory diseases. Turpentine is a gen- 
eral favorite for this purpose, but turpentine is volatile, and its 
effects fugitive, unless volatilization is prevented by the use of 
oiled silk, etc. ; then it may blister or make the surface very ten- 
der and sore. Some skins will not tolerate it at all. Another ob- 
jection to turpentine is the fact that it is so universally adulterated 
you cannot depend upon it. 

The best counter-irritant in bronchial coughs, throat irritations, 
etc., is capscine plaster. 

Suppose you are called to a patient, who has taken cold, is 
coughing incessantly, and cannot sleep. Cut a strip from a cap- 
scine plaster, two inches by four, and apply it just below the prom- 
inence of Adam's apple. In a short while your patient will stop 
coughing and go peacefully to sleep. 

In many spasmodic affections, neuralgic pains, etc., you will de- 
rive benefit from counter-irritation. In hiccough, obstinate vomit- 
ing, dysenteric diarrheas, colics and congestions of any of the in- 
ternal organs, counter-irritation will aid your treatment greatly. 

The means for applying some form of counter-irritation prompt- 
ly are to be found in every household, and will furnish you some- 
thing to do while you make out your diagnosis and decide upon 
your treatment. It is always a relief to the patient and the family 
to see the Doctor set to work to do something. Counter-irritation 
conflicts with no treatment which may afterward be decided upon, 
and the amelioration which follows its use is gratefully remem- 
bered by your patrons. 



350 



STAMMERING. 

Prof. Georges Delon, of Paris, France, read before the Academy 
of Medicine, of Cincinnati, a very interesting and instructive ad- 
dress on -"Stammering." Stammering, stuttering and the impedi- 
ments of speech, he said, are a fact and all theory is important, if 
not to explain at least to prevent them. 

It would be difficult to refer the various defects of speech to one 
general cause. Sometimes the defect is organic or hereditary, at 
other times the result of contagion, which is nothing more than a 
bad habit, most generally both. Among people afflicted with stam- 
mering we ordinarily notice that the vocal organs are weak and 
stiff, wanting in strength and suppleness. In many cases, also, 
the tongue is too long or too short, too thin or too thick ; the teeth, 
the lips, and the palate cavity affect some peculiar disposition, the 
root of the tongue completely covering or too much disclosing the 
opening of the throat. In a word, the conformation of the vocal 
organs is sensibly different from the normal appearance presented 
among persons who speak fluently. The respiratory organs are 
also in a bad condition and do not work regularly. 

Another characteristic of a stammerer, while being a conse- 
quence and at the same time a cause of his trouble, is an extreme 
nervousness, and we may remark that it is not the least of the 
difficulties to overcome. 

Another effect of that disease, which contributes to augment it, 
is an excessive timidity, which makes the disease both mental and 
organic. 

It would be impossible to suppress stammering by modifying 
the organs of which we have spoken by means of a surgical opera- 
tion. Some trials formerly made to that purpose have proved a 
failure, and have maimed the patient for life. 

The stammerer must be able to speak with his organs just as 
nature has made them, since there is no possibility of changing 
them. The question is to teach him how to make the best possible 

351 



352 MEDICAL AND SURGICAL EMERGENCIES. 

use of them, to harmonize their functions, and it is necessary, 
before all, to improve the condition of those organs, to give them 
the strength and suppleness they need. • 

There is, indeed, never a person afflicted with a defect so intense 
that he did not succeed at times, not knowing it, in pronouncing 
every sound and in articulating every rnovement ; therefore, there 
is no organic impossibility to utter certain articulations. The de- 
fect lies in the ignorance as to how to direct the organs, difficulty 
of these organs to obey the will and inaptitude to produce some 
sounds and movements. 

Although the contrary has been said by eminent men the cure 
of stammering is always possible in all cases where the organs 
have not been mutilated nor struck with paralysis and the cure 
must every time be sure, but not without hard work and persever- 
ance. 

The aim of treatment is to remove the organic troubles by reg- 
ulating the respiration by giving to the organs of speech, by means 
of rational and repeated exercise, the necessary strength and sup- 
pleness. The effects rapidly manifest themselves, and the desired 
results soon obtained have also an influence on the general condi- 
tion of health. 

The pupil must be taught the formation of sound, the value of 
each letter or combination of letters, the articulation of movements 
and the regular and natural mechanism of all the vocal organs. 
Afterwards, by means of gradual and progressive exercises, the 
patient is brought to the natural tone of conversation. 

The time required to pursue these periods of exercise after 
Prof. Delon's method is only three weeks ; in many cases the pupil 
is able to attend his business after ten or fifteen days. 

Advice to the pupils who have followed this course : 

1. We call the attention of our pupils to the fact that they must 
apply themselves seriously and with perseverance to practice our 
system, until it becomes a settled habit with them. 

2. Before speaking they must be careful to take a full and quiet 
breath and to renew their respiration according to the sense of the 
phrase, and never to speak when the air is exhausted. 

3. Put into practice the observations made relative to the move- 
ments of the lips and tongue. 



MEDICAL AND SURGICAL EMERGENCIES. 353 

4. Preserve a good syllabation. This is easily hidden by the 
intonations and inflexions of the voice. 

5. Speak with assurance, watch over the emission of your 
words, exercise full control over yourself, and the more you feel 
embarrassed the more you must speak slowly, coolly and deliber- 
ately, in a word be ever on your guard and watch yourself atten- 
tively. 

6. We may sum up our system in three words : Respiration, 
syllabation and tranquillity. These include everything and they 
are equally indispensable. 

7. Take advantage of all opportunities to speak slowly, as for 
instance when you are with your family or friends. 

Prof. Delon does not believe in the possibility of self-cure, al- 
though he has met with some cases where, in the course of time, 
after maturity, the-impediment decreased. The intelligent and en- 
lightened direction of a professor is indispensable. 

It is for the professor a work of patience, of devoted attention, 
which necessitates most peculiar care. The instructor must also 
act on the morals of the patient, succeed in receiving his complete 
confidence, and succeed in suppressing at the same time the mate- 
rial defect and the trouble arising partly from his timidity and 
peculiarities of temper to which persons afflicted with stammering 
are too often inclined. 

Of course complete success depends, in a good measure, on the 
patient himself. Average intelligence alone is sufficient; but the 
greatest atention, the most constant care, good will, energy and 
perseverance are necessary to obtain a brilliant result. 

The pupil must be prudent and patient, above all. in the begin- 
ning, in order to forget his bad habit of speaking and to have him 
to acquire the new one. He must never lose sight of his aim to 
improve his speech, perfect his cure. 

In short, to cure stammering is to teach the science of speech. 
We teach the pupil how to speak in the most natural way, without 
effort to gain absolute control over- his organs, to become com- 
pletely master of himself. The cure being once effected, the tem- 
per and social habits of the patient are advantageously modified. 
The stammerer once cured becomes quite a new man. 

For a child under ten years it is very easy to rectify and im- 
23 



354 MEDICAL AND SURGICAL EMERGENCIES. 

prove the organs, and it is only a work of patience. At the age of 
fifteen the defect has not become deep rooted and the cure is still 
easily effected; but after that age the cure is more difficult, the 
disease more serious, and it is only with a man of fully developed 
intellect, that is to say after the age of twenty-five, and the de- 
crease of the nervousness characteristic of younger people, that we 
find great assistance in effecting a cure. If parents would give 
more attention to the defects of the young child beginning to stam- 
mer, if instead of laughing or 'becoming angry, they knew some- 
thing about treating their child and teach him to speak and over- 
come the growing defect, if above all, parents were never to let 
any nervous child associate with any stammerer, or hear him 
speak, stammering would disappear, 



DRINKS. 

The Drinks, Food, Baths, Exercise and Clothing in 

Bright' s Disease. 

i. Drinks. Drink one-half pint hot water, clear, weak tea, or 
clear, crust coffee, one hour before each meal, and on retiring. 
Drink a cup (eight ounces) of clear tea or coffee, of beef tea 
(made from beef, freed from fat and connective tissue) at each 
meal. When thirsty, between two hours after and one hour be- 
fore the next, drink hot water, clear tea, or beef tea freed from 
fat or gelatine. Take no other drinks of any kind. If the hot 
water sickens the stomach, sprinkle in a little salt, just enough to 
take off the flat taste. 

2. Food. Eat broiled beefsteak, carefully freed from fat, con- 
nective tissue, cartilage and bone before cooking. Have it sea- 
soned to taste with pepper and salt. For variety use the steak 
(broiled), which is cut through the center of a round of a lamb 
or mutton, broiled oysters, broiled quail, broiled grouse, broiled 
woodcock, broiled snipe, broiled partridge, and broiled codfish. 
The white of eggs may be taken raw or soft boiled. Avoid all fats 
as far as possible, only using salt and pepper for seasoning. Mus- 
tard, mixed up with hot water and lemon juice, or Worcestershire 
or Halford sauce, may be used on meats if desired. A little celery 
may be eaten at dinner. 

Avoid pies, cakes, pickles, vinegar sauce, soups, cheese, cream, 
milk, yolks of eggs, fat, sugar, crackers, bread, biscuit, beans, peas, 
nuts, fruits (except the juice of the lemon), vegetables and all 
other food and condiments not previously mentioned. This rigid 
diet should be kept up till all traces of albumen and casts disappear 
from the urine. 

When these have ceased to show themselves for a couple of 
weeks, the patient may be allowed one part of bread, toast, or 
boiled rice, by bulk, to eight or ten of the beef. After continuing 

355 



356 MEDICAL AND SURGICAL EMERGENCIES. 

this departure for four weeks, without any appearance of albumen 
or casts in urine, the bread, toast, or boiled rice may be increased 
to one part, by bulk, to six parts of the meat, and a piece of butter 
the size of a hickory-nut allowed for seasoning. 

After continuing these proportions for four weeks, if still no 
signs of albumen and casts show themselves, the bread, toast, or 
rice may be increased to one part to five of the meat, with a little 
increase of the butter. Continue all these proportions for one 
month. If no albumen or casts appear in the urine, increase the 
bread, toast or boiled rice to one part to four of the meat, and con- 
tinue this for a month longer. If all is well at the expiration of 
this time, give the succeeding month, one part of bread, toast, or 
boiled rice, to three- of the meat, with a little increase of the butter. 
Continue these proportions for three months, and then, if no sign 
of the disease shows itself, increase the bread, toast, or boiled rice 
to one part, by bulk, to two of the meat. Cracked wheat may now 
be brought in as a change from the rice. After continuing this 
diet for a couple of months, if all goes well, and no signs of albu- 
men or casts appear in the urine, milk, warm from the cow, two 
hours after breakfast and dinner, may be taken. The patient 
should go out to the cow and drink the milk as soon as it comes 
from the teat, with all its animal life and heat. Begin with half a 
pint, and gradually increase till the patient is taking a pint at a 
time. After continuing this system of alimentation for a couple 
of months, if the patient continues to thrive, and is advancing 
gradually toward health, a little fruit may be indulged in after 
dinner. This indulgence, however, must be carefully controlled, 
and the patient not allowed over one peach, apple, orange, or 
bunch of grapes per day. Sugar and cream, also, may be very 
moderately indulged in, in tea and coffee. 

This system of diet should be followed out for many months; 
and if no signs of the disease show themselves, it may be contin- 
ued, gradually extending the diet list. It will be well, however, as 
a general rule, to continue to take two parts of lean meat (broiled 
or roasted) to one of all other food. 

If at any time during the treatment, after the albumen and casts 
have disappeared from the urine, they begin again to show them- 
selves, as the diet becomes more liberal, the patient should at once 



.MEDICAL AND SURGICAL EMERGENCIES. 357 

come squarely down to lean meat diet, as he did at the start, and 
proceed cautiously as before. 

The patient will lose in weight during the early part of the 
treatment, but this need not excite anxiety ; for after the first few 
weeks, this loss will be checked, and a gradual gain will set in. 

3. Meals. The meals should be taken at regular intervals, and 
it is better to eat alone, or only with those that are living on the 
same diet. All temptations should, as much as possible, be re- 
moved from the patient. If three meals a day are not sufficient to 
satisfy hunger, the patient may be allowed a nice piece of broiled 
steak between breakfast and dinner and between dinner and sup- 
per. These extra meals should be taken at fixed and regular in- 
tervals. If care is taken in following out this plan of diet, it will 
not be long before the system gets in good order, the digestion and 
assimilation will go on nicely, and the patient will eat largely and 
with great relish. You will often be assured by the patient, that 
there is no food so nice as a good broiled steak, and he will sur- 
prise you by eating all the way from one to two pounds at a meal. 
Never eat on a tired stomach. Rest one hour before and after 
each meal ; eat slowly, and masticate the food well. 

4. Baths. Take a soap and hot-water bath twice a week for 
cleanliness, after which rub with a coarse towel till the skin is red. 
Every night or day, sponge all over with hot water, in which put a 
teaspoonful of aqua ammonia to the quart of water ; rub in well, 
and afterward wipe dry. 

5. Exercise. Ride daily in an easy buggy or carriage as much 
as possible without fatigue. If not able to walk or ride, the body 
and limbs should be rubbed, kneaded and pounded all over for 
from ten to twenty minutes — morning, noon and night — by some 
one who has strength to do it thoroughly. 

6. Clothing. Wear flannel or silk next the skin, and dress com- 
fortably warm. On retiring, change all the clothing worn during 
the day, so that it may be thoroughly aired for the following morn- 
ing. Keep the clothing sweet and clean by changing every second 
or third day. 

The bed should be thrown open on rising and the bedding well 
aired during the day, and the bed not made up till the patient 
wishes to retire. Good ventilation is verv essential. No tonics, 



358 MEDICAL AND SURGICAL EMERGENCIES. 

mineral waters, or external applications should be used ; the physi- 
cian will give remedies which are needed. 

General remarks. Remember that the medicines cure nothing; 
they simply aid in keeping the machine in good running order, 
while the cure is effected by the rigid alimentation — an alimenta- 
tion freed as much as possible from all paralyzing and fat-forming 
elements. The constant and long continued fermentation of vege- 
table food, fruits and sweets in the stomach and bowels keeps the 
digestive organs all the time filled with carbonic acid gas. This, 
after a while, so paralyzes the cells of the surfaces with which it 
comes in contact, that they lose their normal selective power, and 
begin to take up, little by little, and more and more, carbonic acid 
gas, vinegar, yeast, etc., which are carried into the circulation, and 
thus reach every part of the organism. 

The heart, liver, lungs, kidneys, spleen, and brain are among 
the first organs to suffer. The organs that are the first and most 
liable to be paralyzed are the kidneys and heart, the next the por- 
tal glands. 

It is not sufficient to look to weekly or monthly exposures for 
the cause, but to daily and hourly. In creating either healthy or 
diseased habits, the either healthy or pathological acts must be 
regular, frequent, and long continued, in order to become con- 
firmed states of health or established conditions of disease. We 
must reach the underlying causes before we can cure. We may 
relieve and seemingly cure, without knowing or removing causes ; 
but such relieving and curing is not permanent. We should re- 
member that all these states and conditions we bring upon our- 
selves by something we are doing daily and persistently. This 
wrong doing must be stopped, then we may use with advantage 
any means that will help to gradually bring back and establish 
healthy states and habits in the diseased structures, 



SMALLPOX. 

The Management of* Smallpox in the Smaller Municipal- 
ities. 

Smallpox is a contagious and an infectious disease of which the 
specific germ has not been discovered. The exact period of its 
contagion has not been determined, although some who write from 
actual observation place it during the later days of the incubation 
stage, others, during the initial fever, others, during the pustular 
stage, while a few contend smallpox is contagious only in the later 
days of the disease. I am of the opinion, based upon several years 
of close study of the disease at the bedside and of text-books, that 
smallpox is contagious from the later days of the incubation period 
until the entire body is free of scabs and loose scales of epidermis ; 
free of abscesses and abscess scabs. I consider an ulcer of the 
cornea the result of a pustule upon the cornea, capable of trans- 
mitting the poison of smallpox to the same degree as an unhealed 
smallpox pustule. 

transference oe contagion. 

The contagion is conveyed by the breath of the patient, by the 
pustules, by the scabs, by the emanations and the secretions. By 
contact direct or indirect, through letters, papers, clothing, bed- 
ding, articles of furniture, carpets, books, money, articles of mer- 
chandise, the air, by insects, flies, domestic pets, cats, dogs, rats, 
and other things which have become infected by contact with one 
having the disease. 

The infection of smallpox is through the pus, the dried scabs, 
the scales of epidermis or the blood of the patient being deposited 
upon an abraded surface, this may be a pin prick, an abrasion in 
the nostril, upon the lip or elsewhere, the infection, however, is 
absorbed at once by the capillaries into the general system, in- 
creasing in character as it progresses until the system is thorough- 

359 



360 MEDICAL AND SURGICAL EMERGENCIES. 

ly saturated with the poison and the explosion occurs. The rapid- 
ity or slowness of this absorption regulates the period of incuba- 
tion. 

PERIOD OP INCUBATION. 

A period of from five to twenty-one days elapses before any 
effect o*f an infection in an unvaccinated individual appears, when 
he will feel myalgic, this is followed or accompanied by a chill, 
more or less severe, headache, backache, sometimes vomiting and 
abdominal pains, fever of a high grade supervenes and on the 
second or third day an eruption will appear upon the face, wrists, 
and soft palate, to gradually extend over the whole body. This 
eruption is papular and has a shatty feel, but every shatty feeling 
eruption is not smallpox. 

The disease progresses with more or less severity, the papules 
become vesicles, then pustules, then scabs to finally leave the body 
more or less scarred. 

DIAGNOSIS. 

When confronted with a case suspected of being smallpox a 
diagnosis may sometimes be made almost immediately, but there 
are cases which come under observation where difficulties are ex- 
treme. In the early stages, before the eruption, meningitis, 
typhoid fever, pneumonia, later syphilis, erythema, impetigo, vari- 
cella, eczema pustulosa and other affections cause anxiety. Re- 
member every pustule is not smallpox. 

It is not my intention to write at any length upon the entire sub- 
ject, Smallpox, but to note those points which will apply to the 
management of the disease when it appears in the smaller munici- 
palities and the outlying districts, where hospital, disinfectant and 
police facilities are not available and differences in the diagnosis 
of the medical attendants lull the community into a state of false 
security or create one of panic. 

In the largest cities every facility is afforded for the proper 
management of cases of smallpox. In some of them these appoint- 
ments are very complete and the vigilance of medical inspectors, 
ward physicians and sanitary police enables the health officers to 
exercise control over the first recognized cases and in this way 
prevent a more serious infection. Where, however, these first 



MEDICAL AND SURGICAL EMERGENCIES. 361 

cases are not recognized, matters assume a serious aspect and an 
untold number of cases may develop, spreading infection far and 
wide. 

NECESSITY OF HEALTH COMMISSION IN EVERY COMMUNITY. 

In every community, and by community would be meant a thou- 
sand inhabitants with stores, business men and physicians, there 
should be an organized board or commission of health composed 
of physicians and business men, whose duties should be active and 
not merely perfunctory._ This board should have the undivided 
support of the people in everything which concerns health matters 
and its decisions upon these matters should in general be final. 
Occasionally these decisions may be questioned, and these ques- 
tions will arise when smallpox appears ; since the expenditure of 
money is necessary for its management and financial losses to indi- 
vidual members of the community will follow. It is right here 
the board of health of the county must be consulted, but where the 
county is without such a board, appeal must be made through the 
proper officers to the State board of health. 

WHAT SHOULD BE DONE WITH A CASE OE SUSPECTED SMALLPOX. 

Let us suppose a patient under suspicion has smallpox and the 
disease is recognized, the question comes up at once, what shall be 
done with it ? The disease never having occurred in the commu- 
nity before this time, no provisions have been made for its man- 
agement. In this emergency a cool executve head will allay much 
of the panic which is rife. The patient must be isolated, if pos- 
sible in a room at the top of the house ; the inmates of the house 
must be vaccinated and if necessary re-vaccinated a sufficient num- 
ber of times to show an immunity from vaccination ; all the con- 
tacts, that is, all who have been in direct communication with the 
patient, must be vaccinated and quarantined under guard, and 
supported at the public expense if necessary ; all suspects, that is, 
all who have been indirectly exposed, should be vaccinated and 
kept under observation, not necessarily quarantined, for a period 
not less than sixteen days from the time of the last exposure. 
The sick room should be as far as possible from the generally oc- 
cupied rooms of the house. Select the top floor, two rooms at 



362 MEDICAL AND SURGICAL EMERGENCIES. 

least, remove such things as are unnecessary, trunks, carpets, 
woolen hangings and the more expensive ornaments. Leave the 
window curtains in place for they are needed to exclude the strong 
light of the sun, which in a measure produces inflamed eyes. 
Spread alongside the patient's bed, a rug, a piece of carpet or half 
a blanket, this is sufficient covering for the floor, and it can be 
destroyed. Provide proper ventilation without cold draughts.^ 
Preserve a comfortable degree of heat. Hang a sheet, wet with 
an efficient disinfectant, at the door. When necessary to sweep 
the floor use a broom covered with a towel or cloth, brush the 
sweepings into a paper and keep until ready for destruction; the 
same applies to dusting chairs, tables, and other things, but in 
doing this it must be remembered these things must not be shaken 
out a window. 

ARTICLES NEEDED DURING ISOLATION. 

A chamber, a bed pan, a urinal, a sanitary spit cup, a small 
pitcher, a feeding douche, a drinking glass, a medicine glass, 
handkerchiefs, and a small call bell will be all that are needed for 
use, excepting, of course dishes and other table auxiliaries. The 
greater majority of smallpox patients throw off a strong and dis- 
agreeable odor, sickening at times ; it is best combatted with acetic 
ether or carbolic acid placed in shallow dishes and renewed as re- 
quired. When acetic ether fills the air for some time it becomes 
offensive, but not to the same degree as the patient. 

On the mattress of the patient's bed there should be a rubber 
sheet, oil cloth, oil silk or other protective covering. 

A large wash tub or a portable bath tub is necessary to the sick 
room. 

QUARANTINE RULES. 

Nothing should be allowed to be taken from the sick room or 
the house except for disinfection or destruction, nor should the 
inmates of the house remain in this room longer than is absolutely 
necessary. 

The guard line of the house and the quarantine line should not 
be closer to one another than twenty-five feet. Supplies of 
groceries and other things must be left at the guard line to be 



MEDICAL AND SURGICAL EMERGENCIES. 363 

taken to the entrance of the house by the guard where they will 
be deposited. In the case of liquids proper receptacles must be 
provided at both lines. Letters should be dictated to an outside 
party and not written by the inmates of the house. 

DUTIES OF THE ATTENDING PHYSICIAN. 

The physician who attends the case must be under the control 
of the health authorities. His visits must be as many as his 
patient's condition demands, once a day, once in two days and so 
on until the termination of the case either in recovery or death. It 
is necessary the physician himself should not become a means of 
spreading the infection, and with the object of preventing this 
spread, there are certain methods for him to pursue during his 
connection with the case. He must by all means be vaccinated, 
unless he has already been successfully vaccinated within a period 
of seven years, or has had an attack of smallpox ; this applies with 
equal force to the members of his family. Upon his entrance into 
the house, he should remove his coat, vest, collar, necktie, cuffs 
and finger rings, he should then put on a suit of overalls or 
pajamas, buttoned down the front and fitting closely about the 
neck, wrists and ankles, he then puts on a pair of rubber shoes, 
sprays his hair, face and heard with a solution of corrosive 
sublimate, then adjusts a cap, preferably a baker's cap, upon his 
head. For handkerchiefs, gauze cut in suitable pieces is applica- 
ble to all purposes. No reason now exists for putting the hand 
in the pocket as the thermometer, the temperature chart, the pencil 
and the watch are in the sick room. Medicines prescribed should 
be sent to the house and not taken from the medicine case, should 
the physician carry one. The condition of the patient having 
been carefully observed, temperature and pulse, stools and urine 
recorded, directions as to diet and medication given, the disinfec- 
tion and disposal of the stools superintended, he will without the 
exhibition of fear or hurry encourage his patient to assist him and 
the nurse in the successful management of the case, see the other 
inmates of the house, give them such information as will make 
them aware of the condition of the patient, but not give too 
favorable a prognosis, for smallpox is a very treacherous disease. 
His visit completed he will, without any further communication 



364 MEDICAL AND SURGICAL EMERGENCIES. 

with the people of the house, remove his cap, rubbers and pro- 
tective clothing, wash his hair, face, neck, ears, mouth, arms and 
hands with a solution of corrosive chloride of mercury, taking 
care not to allow his eyes or gold-filled teeth to be injured. With 
clean water he may then wash himself, this however, is a matter 
of choice. The clothing which he removed at first is again put 
on and he is safe to continue his business. The mercuric solution 
in use by the health department of the District of Columbia, is as 
follows : Bichloride of mercury, 1 part ; acid of hydrochloric, 2 
parts; water, 1000 parts. For the sake of convenience Johnson's 
antiseptic tablets of hydrarg. chlor. corros., grs. J.y, ammonium 
chloride, grs., 7.3 ; Bernays' tablets, corrosive sublimate, gr., if ; 
acid citric, grs., 87-100; each tablet in a pint of water makes a 
solution of the strength of 1 to 1000. Either of these solutions 
will cause cracking of the skin after frequent use, therefore a 
glycerine hand lotion is advisable at night. 

duties OF the: nurse. 

The nurse, who as a matter of course, must be an immune, 
either by vaccination or an attack of smallpox, should be provided 
with a washable wrapper and a cap which must be put on each 
time she leaves the patient's room ; it must be kept in the hall just 
outside the sick room. She must not associate with the other 
inmates of the house more than is absolutely necessary. In this 
way general infection of the premises is in a measure avoided. 
Cheerfulness in the nurse is a trait to be encouraged, while levity 
and undue familiarity are to be discouraged. Patients must not 
be allowed out of bed until the greater majority of the scabs are 
off, they must be cautioned not to throw them on the floor, but 
must collect them in paper envelopes, bottles or chambers for dis- 
posal by fire. 

DISINFECTION OE ARTICLES. 

Sheets, pillow slips, towels, gowns, handkerchiefs and other 
washable material used by the patient or in the sick-room must 
be soaked in a solution of bichloride of mercury, carbolic acid or 
Camphenol, wrung out and either boiled thoroughly or burned. 
As a general rule the destruction of property is not to any extent 



MEDICAL AND SURGICAL EMERGENCIES. 365 

necessary. The stains made by the rupture of the pustules, fecal 
matter and medicines will disappear after proper attention and 
subsequent washings. 

Abbott, in regard to the body and bed clothing, recommends an 
immediate immersion in the following solution: Carbolic acid, 3 
parts; common soft soap, 2 parts; cold water, 100 parts. The 
articles are allowed to soak for two hours when they may be rinsed 
out in clean water and then laundried, being first boiled. The 
solution he recommends is cold and will destroy non-spore bearing 
bacteria as well as dissolve out blood and fecal stains. If these 
things are first soaked in hot water, boiled, subjected to the proc- 
ess of steaming, or soaked in a solution of bichloride of mercury, 
1 to 1000, the stains are indelibly set. 

METHOD OF DISINFECTION IN GERMANY. 

In Germany wash that is soiled is treated by the following 
process : it is wrapped in a sheet wet with a sublimate solution, and 
this placed in a sack likewise moistened with a germicidal liquid. 
The sack is placed unopened in a solution containing 3 per cent, 
of soft soap, and heated to 50 C. for three hours and left in the 
same solution forty-eight hours after it cools. If not soiled with 
albuminous matter the wash is immersed in a solution of bichloride 
of mercury, 1 to 2000, with the addition of common salt. After 
this preliminary disinfection, the articles are boiled half an hour 
in a water containing : Petroleum, 10 gm ; soft soap, 250 gm ; 
water, 30 liters. 

The addition of kerosene, water of ammonia, soapine, laundry 
bleach or other washing compound will, with the proper use of 
the washboard, hasten the removal of the stains. 

DISINFECTION OP PREMISES AND PERSONS. 

After the recovery of the patient the disinfection of the premises 
and persons is begun, and here the ingenuity of the disinfector 
has full sway. The contacts at the expiration of the quarantine 
period having been rendered immune by vaccination are given a 
full body soap bath, they are then taken to the door of a disin- 
fected room where they strip off all clothing, they then pass into 
the room where they take a full bath of bichloride of mercury, 



366 MEDICAL AND SURGICAL EMERGENCIES. 

taking care not to injure the eyes. Disinfected clothing is fur- 
nished and they leave the premises. The patient having had 
several soap baths during the illness, goes through these processes 
and then the nurse, following the same course, the disinfection of 
the premises now begins. 

The absence of sewerage will necessitate special care in the dis- 
posal of the fecal excretions, the cloths used about the patient, the 
remnants of food, the accumulating sweepings of the sick room 
and the dried scabs. A simple and very effective method of deal- 
ing with these matters is to procure a stout wooden box, thickly 
coat it on the inside with plaster of Paris, this renders it practically 
water-tight, partly fill it with sawdust, pour in carbolic acid rather 
freely and stir ; with an adjustable lid the box is now ready. Bed- 
pans and chambers can now be safely emptied into it, stirring well 
during the emptying, other matters can also be placed in it. When 
sufficient matters have been accumulated the box may be emptied 
in the yard upon saw-dust, dried hay, straw or excelsior well 
sprinkled with kerosene oil and the entire pile set fire. The box 
is then prepared for the next day's accumulation. 

Preference is given to carbolic acid over bichloride of mercury 
for the reason that the latter permits the formation of a coating 
of the albuminate of mercury and possibly would defeat the very 
object of its original application, that is, the destruction of the 
disease germs. 

All dishes and other utensils should be washed first in a solution 
of bichloride of mercury, trikresol, or one of the preparations of 
carbolic acid, then rinsed in clear water before being used again ; 
they must not be handled by anyone except the nurse and not 
allowed to be taken from the sick-room. 

ISOLATION QUARTERS. 

For the accommodation of transient visitors or tramps in a 
village, some provision should be made for the proper sheltering 
of such of these persons who may be infected with such diseases 
as smallpox, scarlet fever or diphtheria. While this is true, it is 
not to be supposed expensive buildings will be erected. The tent 
hospital and barracks or portable hospital should be a part of the 
belongings of every municipality. It is not necessary to destroy 



MEDICAL AND SURGICAL EMERGENCIES. 367 

these as their thorough disinfection and fumigation are easily ac- 
complished. They are always ready be the emergency what it 
may. Some larger cities rely on tent hospitals for smallpox, others 
upon portable buildings. 

It is not necessary to discuss vaccination further than to say it 
must be done where protection from smallpox is desired. 

School Boards have the right to issue regulations governing 
the attendance upon classes of such children as have been exposed 
to the infection of smallpox and other diseases irrespective of any 
regulations issued by Health Boards. Therefore, children from 
infected premises should not be allowed to return to school until 
sixteen days after the disinfection of the premises for smallpox. 
All books used by the children must also be thoroughly disinfected 
or destroyed. By ''disinfection of the premises" is meant the time 
the premises are declared free from infection. 

MORTALITY RATE. 

The mortality rate of smallpox is from 2 per cent, to 80 per 
cent., an average of 22 per cent, will be the rate where cases 
receive medical attention and care. Many cases will recover with- 
out any care, some will continue their daily labor with little or no 
inconvenience, still this is no argument for a do-nothing policy. 
The rate in discreet cases, where cardiac or pulmonary lesions do 
not exist may be stated at 2 per cent, for all ages ; in semi-confluent 
and in confluent cases the range is great, while in hemorrhage 
cases it is uniformly fatal, 100 representing the rate. A very 
great difference exists between hemorrhagic smallpox and those 
cases where hemorrhage into the pustules occurs, in this latter 
variety the pustules take on a bluish appearance and recovery 
following gives the impression of recovery after hemorrhagic 
smallpox. 

PROPER DISPOSITION OF THE DEAD. 

In my opinion the proper disposition of the body dead of small- 
pox, or of any infectious disease, is cremation. A source of in- 
fection is thereby wiped out, this plan, however, is not popular, 
therefore earth burial will continue. 

A body properly prepared for its final disposition has been 
treated in the following manner: Washed in a solution of bi- 



368 MEDICAL AND SURGICAL EMERGENCIES. 

chloride of mercury, I to 80 ; sprinkled freely with chloride of lime 
the orifices of the body closed with absorbent cotton; the night 
clothing adjusted; it is then wrapped in a sheet well wet with 
the bichloride of mercury solution, this sheet is tightly pinned or 
securely sewed, the whole is now placed in a blanket and put in 
the coffin. The coffin lid is nailed down and then carried to the 
place of burial. The grave must not be less than seven feet deep, 
lime is thrown in, the coffin lowered, more lime is thrown in and 
the grave filled. This grave must never be opened. 
I Public funerals, viewing the body and a gathering of friends 
at the place of burial are to be prohibited. Carrying a body from 
one state to another is generally prohibited by law, so should the 
transportation from county to county in the same State. 
§ 

SUGGESTIONS TO SMAU.P0X NURSES. 

Give particular care to the disinfection of the person. A bath 
should be taken at least once every day. A Germicidal Soap, or 
another designated Cresol Soap is advisable for this bath. As 
much as possible the nurse should avoid sitting down in the sick- 
room, especially sitting upon the bed or even leaning against the 
bed, walls or furniture. 

Wash the hands with Synol or Cresol Soap after each Contact 
with the patient. 

Exercise regularly, if possible in the open air. 

The nurse should be given as much sleep as usual. If the 
patient needs constant care, another attendant should be procured 
if possible. The nurse should wear a washable uniform ; a wash- 
able cap should cover the hair. 

The following rules are applicable to smallpox as well as other 
contagious diseases : — 

Do not put to your lips any food, drink, dish or utensil that the 
patient has touched or that has been in the sick-room, until it lias 
been washed and disinfected. 

Do not go into the sick-room with an empty stomach. Do not 
eat or drink in the sick-room. 

Keep the hands free from all discharges from the sick. If the 
hands are accidentally contaminated wash them as soon as possible 
with Synol Soap. 



MEDICAL AND SURGICAL EMERGENCIES. 369 

If the hands are scratched or cut, put court plaster or adhesive 
plaster over the wounds. Never touch the sick with sore or 
scratched hands. 

Kill or drive out of the sick-room all flies or other insects. Be 
particular to destroy all mosquitoes. 

Keep the room at a temperature of 70 . Keep the room always 
well aired, yet at as even a temperature as possible. 

Let in all the direct sunlight possible, unless it seems to hurt 
the patient's eyes. 

If the patient's eyes are affected by sunlight paste red paper 
over the glass or paint them with a red paint. When thus treated 
the light will be very beneficial. 

Bedding should be changed frequently. Throw the soiled bed 
clothes into a tub or pail containing a solution of Camphenol, (one 
teaspoonful of Camphenol to a quart of water), before removing 
them from the room. In taking the soiled bedding from the room 
to be washed, wrap it in a sheet dampened with this Camphenol 
solution. 

Towels, napkins or bandages should always be clean. They 
may be used more than once it they are taken from the room and 
disinfected every time. 

All dishes, cups, glasses, spoons and utensils which have been 
used in the sick-room should be disinfected before being taken 
from the room. Scalding hot water containing from two to four 
spoonfuls of Camphenol to a quart of water should be used. 

Any article such as shears, toys, combs, brushes or anything 
handled by or that has come in contact with the patient, should 
likewise be disinfected before being removed from the room. 

It is a good safe rule in these diseases to consider that every- 
thing that has been carried into the sick-room has become infected, 
and needs disinfecting before being carried out and used else- 
where. 

The dishes which the patient uses should not in turn be used by 
others, or washed with other dishes. The food should be brought 
into the room just before the patient is ready for it. 

All articles of food left over should be burned, or else mixed 
with Camphenol and buried. 

Milk or other food must not be allowed to stand in the sick- 

24 



370 MEDICAL AND SURGICAL EMERGENCIES. 

room, and whatever drink or food has been in the room must not 
be used by others or fed to dogs or cats. 

Bodily discharges from the sick should all be considered 
dangerous. 

Excreta from the bowels or kidneys should be immediately 
covered with a solution of Camphenol (one teaspoonful of Cam- 
phenol to one pint of water). 

Vessels containing the discharges and Camphenol should be 
shaken or otherwise stirred, and after a half hour may be thrown 
into the sewer or be buried in the ground. The discharges should 
never be thrown where they might contaminate a running stream. 
They should not be buried within a hundred feet of any well or 
stream. 

Vessels used to catch discharges should be thoroughly disin- 
fected with boiling water containing a tablespoonful of Camphenol 
in each pint. 

VACCINATION. 

The efficacy of vaccination and the need for its continuance is 
beyond dispute. There are at hand many figures, statistics com- 
piled from all nations, which conclusively show an enormous 
lowering of the death rate traceable to vaccination alone. How- 
ever the frequency of dangerous consequences after the inocula- 
tion and undoubtedly due to it are recognized. Our belief in 
regard to these cases is that the difficulty is caused by infection 
at the time of the operation ; that is, to carelessness on the part 
of the vaccinator. I consider the trouble as arising in nearly every 
case from the fact that the inoculation has been attempted by un- 
skilled persons or that the physician has been careless. 

One of our best authorities describes his method of vaccination 
as follows: 

''The skin is made as nearly aseptic as possible by scrubbing it 
with soap and water, using an ordinary surgical brush. Recently 
I have used Germicidal Soap, which I find to be powerfully cleans- 
ing and convenient, while at the same time it does not interfere 
with the success of the inoculation. I next treat the skin with 
alcohol, then with ether, again with sterilized water, and finally 
dry the surface with sterilized gauze or cotton. I scratch the 
skin superficially over an area of about one quarter of an inch,. 



MEDICAL AND SURGICAL EMERGENCIES. 371 

making four or five parallel scarifications, and as many more 
across the first at a right angle, causing no bleeding if possible. 

"The lymph is conveyed to the scarifications and thoroughly 
rubbed in with the spade which, as well as the needle, should be 
furnished sterile by the manufacturers. Before I devised my shield 
I allowed the serum to dry exposed to the air. After drying I 
covered the wound with an aseptic gauze compress, fastened with 
strips of adhesive plaster. I give the patient very strict instruc- 
tions as to the importance of returning for inspection and possible 
after-treatment, and not to disturb the dressing." 



EXCESSIVE EATING AS A CAUSE OF 

DISEASE. 

There is no doubt that an excessive indulgence of the ap- 
petite is a recognized cause of a long list of ailments, but the 
question is what constitutes excess in this matter. All that is 
not appropriated is excess and the system must suffer even- 
tually from the non-physiological effort to rid itself of this ex- 
cess. 

I have met with cases of intractable eczema pudendi in 
women past middle life, of sedentary habits, and eating three 
large meat meals a day, and trying by all means in their power 
to stimulate their appetite, under the erroneous impression 
that they are "keeping up their strength." In these and similar 
cases, medicine and local treatment are almost equally useless, 
unless there is at the same time, a thorough reform in the diet. 

The first point is to deprive the patients of sugar as an 
article of food, except just enough to make light puddings 
palatable. The reason for this is that much of the sugar passes 
the liver unchanged, and is therefore worse than useless as a 
food. 

The next point is to greatly reduce the animal food, especially 
mutton and beef, and to substitute for it simple clear soup, and 
poultry or fish in moderate quantity once a day. Lastly, the 
chief part of the daily diet should be made up of light farina- 
ceous and milk food, such as rice, bread and macaroni. This 
is contrary to the view often entertained that saccharine urine 
should be treated by animal diet and that starch should be as 
much as possible excluded. 

Whatever good may result from such a diet in some cases, 
I am quite sure that it does not answer in those to which I 
refer ; on the contrary exactly the reverse holds, and the old 
routine practice, except so far as sugar is concerned, is quite 
wrong. 

372 



MEDICAL AND SURGICAL EMERGENCIES. 373 

Many times the sugar disappears from the urine and the 
eczema departs under a change of diet such as I have above 
recommended. 

Many people at sixty, when the tissue changes are slow, 
eat as much, or more than they did at twenty, when all the 
processes of change are at the height of their activity; what 
wonder then, that unnatural work is thrown upon the skin, 
kidneys, and other excreting organs of the body. 

There is some substantial truth in the saying that "small eaters 
live the longest." 



SUGGESTIONS CONCERNING EDUCATION 

OF YOUTH. 

Overworking the Undeveloped Brain — Headaches in Chil- 
dren . 

"Overwork," properly so-called can only occur when the 
organ upon which the stress of the labor falls is as yet imma- 
ture, and therefore, in process of development. When an organ 
has reached the maturity of its growth it can only work up to 
the level of its capacity or faculty for work. Fatigue may pro- 
duce exhaustion, but that exhaustion will come soon enough to 
save the organ. 

Repeated efforts may, under abnormal conditions, follow 
each other too rapidly to allow of recuperation in the intervals 
of actual exertion, and as the starting point will, in each succes- 
sive instance, be lower than the previous state, there may be 
a gradual abasement ; but even this process should not seriously 
injure a healthy and well developed organ. In short, a great 
deal of nonsense has been said and written about the "over- 
work" of mature brains. 

Nevertheless there can be no room to question the extreme 
peril of overwork to growing children and youths with un- 
developed brains. 

The excessive use of an immature organ arrests its develop- 
ment by diverting the energy which should be appropriated to 
its growth, and consuming it in work. 

What happens to horses which are allowed to run races too 
early happens to boys and girls who are overworked at school. 

The competitive system as applied to youths has produced 
a most ruinous effect on the mental constitution which this 
generation has to hand down to the next, and particularly the 
next but one ensuing. 

School work should be purely and exclusively directed to 

374 



MEDICAL AND SURGICAL EMERGENCIES. 375 

development. "Cramming" the young for examination pur- 
poses is like compelling an infant in arms to sit up before the 
muscles of its back are strong enough to support it in the up- 
right position, or to sustain the weight of its body on its legs 
by standing, while as yet the limbs are unable to bear the burden 
imposed on them. A crooked spine or weak contorted legs 
is the inevitable penalty of such folly. 

Another blunder is committed when one of the organs of 
the body, — to wit, the brain — is worked at the expense of other 
parts of the organism, in face of the fact that the measure of 
general health is proportioned to the integrity of development, 
and the functional activity of the body as a whole in the har- 
mony of its component systems. 

No one organ can be developed at the expense of the rest 
without a corresponding weakening of the whole. 

HEADACHES IN CHILDREN. 

When a child complains of headache most careful scrutiny 
is demanded, and if it be too young to describe its sufferings 
its manner and appearance are highly suggestive of some cere- 
bral disturbance. 

Look at the little child of some ten or twelve months old, 
who is well developed and comes of healthy parents. There 
is the excitement of dentition, and the little thing is observed 
to put its tiny hand to its head, which it rolls, perhaps, from 
side to side, and the anxious mother at last detects a slight 
irregularity in the muscular movements of the eyeball. Reflex 
nervous irritation is conveyed through the fifth nerve to the 
brain, and irritation so awakened may be followed at any 
moment by a convulsion. 

The child is wakeful, uneasy and restless. The brain, so 
needful of rest at this early period of life, is susceptible of mis- 
chief. 

Habitual headaches in older children indicate an exhausted 
and irritable brain, and if intellectual exertion be carried too 
far in such cases mischief is likely to ensue. It seems extra- 
ordinary that educated persons who have the care of young 
people should not see this danger in the anemia produced by 



376 MEDICAL AND SURGICAL EMERGENCIES. 

overstudy, the irritability and excitability of manner, and the 
impossibility of concentration, so necessary to the accomplish- 
ment of any undertaking. 

If intellectual exertion be carried beyond a certain point the 
brain becomes anemic, fatigued, and the nutrition in the gan- 
glionic cells of the cortex becomes impaired, diseased, or in some 
way altered from health. Whatever may be the exact change 
in these cells, due perhaps in a great measure to the absence 
of healthy blood, the inference is most probably correct that 
children so suffering can not readily grasp new ideas ; and if 
strong and powerful efforts are put forward in this direction 
the knowledge is not retained, the object is frustrated, one idea 
is mixed up with another, and confusion results. 

This, I apprehend is just enough to illustrate the grand prob- 
lem that the body must be looked to as well as the mind ; and 
the younger the child, the greater is the necessity for the delay 
of intellectual training. And it does strike one as very extra- 
ordinary that the nervous system, which is the last to attain 
complete development, should be the first to be overtaxed in 
this age of forcing and strain, when revolutionary ideas are apt 
to overrule the judgment. 

It is not that the moderate exercise of the brain in early life 
is injurious ; on the contrary, it is conducive to health. The 
mind is then flexible and plastic, impressions are enduring, and 
habits of concentration are easily acquired. It is the premature 
and excessive exercise of it which is harmful when the bodily 
powers need the chief attention. 

No rigid rules, no cast-iron system, will do for the training 
of all children. All are not cast in the same mold. Any sys- 
tem of education must be elastic, since mediocrity is the rule ; 
and if more be expected of some children whose physical devel- 
opment is at the same time feeble, then disease or premature 
ill health is the consequence. 

Headaches are often hereditary. They have attacked chil- 
dren of the same family who have been brought up at a dis- 
tance from one another, and whose surroundings have been 
quite different. 

In such cases there is something peculiar in the nervous sys- 
tem itself — a tendency to nervous disease. It will, I think, be 



MEDICAL AND SURGICAL EMERGENCIES. 377 

often found on inquiry, that the parents of such children are 
liable to nervous disease, nervous exhaustion, paralysis, etc., 
and perhaps some children of the family have had epilepsy, 
chorea or asthma. 

In many instances too there is some faulty condition of the 
blood. The brain, badly nourished through a scanty supply 
of blood, and that poor in quality, loses its balance and cannot 
resume its tone. 

Neuralgic headache (one-sided headache) is not a very com- 
mon type in children, but it oftener occurs than is generally 
supposed. It is met with chiefly among three classes of chil- 
dren : 

1. Those of the neutral temperament, whose nervous sys- 
tem is easily fretted, excited, and therefore sooner exhausted. 
If such children are pressed too much with their studies, then 
they the more readily suffer. Any degree of intellectual exer- 
tion is exciting to children of timid and delicate constitution, 
who are not only too anxious to learn, but can not throw their 
studies off the mind. 

2. Those children who have been reduced by some long and 
exhausting illness, in-door confinement and bad air. 

3. Those born of delicate parents, and who are badly fed. 



SLEEP. 

The Physiology oe Sleep — The Necessity oe Sleep — The 
Sense oe Fatigue — Amount oe Sleep Necessary — Dreams. 

the physiology op sleep. 

It has been sufficiently demonstrated that during sleep the 
brain is relatively anemic. During sleep, all the blood-vessels 
of the brain are under a diminished pressure, and this lessen- 
ing of the active flow corresponds with a diminution of cerebral 
function. 

This is in accordance with the facts of physiology generally: 
the performance of function is characterized by vascular full- 
ness and activity ; the cessation of function is attended with 
decrease of the vascularity and volume of a part. 

The immediate cause of sleep, however, is not simply the 
shutting off of a portion of the blood current from the brain. 
The lessening of the blood supply is rather the accompaniment 
than the cause of sleep. The true cause is the torpor of the 
cerebral cells. 

This torpor may be the result of waste, unbalanced by repair, 
of the hemispherical ganglia, which become functionally in- 
active owing to diminution of oxidizing material, as well as to 
clogging of the venous and lymphatic channels by the accumu- 
lated debris of organic combustions. 

But this is not all. As the effete products of cell function 
have a paralyzing action on the cells themselves — a truth 
exemplified even in the protoplasmic life of microbes, which are 
now known to generate by their activity poisons. 

Lactic acid is one of the principal waste products whose re- 
tention in the blood causes sleep, but lactic acid is only one of 
the toxic products of the living economy ; the urinary salts 
are also destructive of cell life, and every cell is a laboratory 

378 



MEDICAL AND SURGICAL EMERGENCIES. 379 

of poisons, which exercise their injurious effects on the organ- 
ism as soon as the emunctories are incompetent thoroughly to 
perform their task of elimination. Bouchard, who has per- 
formed many interesting experiments on animals by injecting 
the urine of various physiological and pathological states, finds 
that the urine of the day possesses a poison twice as great as 
that of the night, and that the former produces narcosis, while 
the latter possesses convulsivant properties. 

THE NECESSITY OF SLEEP. 

It is a law of nature that every kind of force or energy 
emanating from the organic or inorganic world shall be the 
exact equivalent of some pre-existent kind of force. This is 
the doctrine of the correlation and equivalence and persistence 
of force now universally admitted. The power that drives the 
piston rod of the steam engine existed latent in the coal as 
static force, originally coming in the form of dynamic force — 
light and heat — from the sun, the great primal source of power. 

In the galvanic battery we see chemical force converted into 
electricity, and in the conducting wire we have the transforma- 
tion of electric force into heat. In the organic world we witness 
the metamorphosis of light, heat and chemism into those forces 
which are called vital. 

It is a truism to say that all organs that are exercised must 
have rest. After every considerable effort of the muscular 
system, a greater or less incapacity for further exertion re- 
sults, and the subjective expression of this incapacity we call 
fatigue. 

The tired muscles obtain a measure of repair during the in- 
tervals of work, and such intervals may be frequent during 
the waking hours. We often rest one set of muscles when we 
are working another set. Even those actions which are most 
continuous, as respiration and the pulsations of the heart, have 
distinct periods of suspension. It is a mistake to suppose that 
the heart and lungs never rest. 

After each contraction and dilatation of the heart, there is a 
pause of one-fourth the time of a beat in which the heart rests 
and is repaired. Hence the heart may be said to rest six hours 



380 MEDICAL AND SURGICAL EMERGENCIES. 

out of the twenty-four. After each respiratory act, there is a 
pause equal to one-third of the whole time ; thus the lungs rest 
eight hours of the twenty-four. But for the busy brain, there 
are no sufficient seasons for rest during the working hours ; 
repair and waste are not evenly balanced. Waste has got in 
excess of repair. Not that no repair has been going on during 
the working hours — nutrition is actively going on at all times, 
and in the spinal cord and medulla oblongata it is probable 
that repair ever keeps pace with waste, or falls but little in 
arrear, equilibrium being quickly restored. The peculiar func- 
tions of these lower centres. are of an automatic kind, stimuli 
always producing responsive discharges along established lines. 

It would certainly be for the advantage of every species in 
the struggle for existence that those automatic functions should 
be performed at such an even, uniform rate that repair and 
waste should be in equilibrium. Such is the condition of these 
nerve centers. From minute to minute brief pauses occur, 
when waste is made good by repair. This was shown to be true 
in respect to respiration, the pause after each respiratory act 
giving the bulb sufficient time for repose and repair. 

With the cerebrum the case is somewhat different. "Its 
substance is consumed by every thought, by every action of 
the will, by every sound that is heard, by every object that is 
seen, by every substance that is touched, by every odor that 
is smelled, by every painful or pleasurable sensation, and so 
on. Each instant of our lives witnesses the decay of some por- 
tion of its mass, and the formation of new material to take its 
place." 

Hence the need of that periodical repose we call sleep. 

THE SENSE OF FATIGUE. 

Subjectively, sleep is preceded by a sense of fatigue, which 
is the more pronounced the greater the labor which has pro- 
duced it. Fatigue may be regarded as an expression of waste 
unbalanced by repair ; lactic acid and creatine accumulating 
in the blood cause this sensation by their paralyzing action on 
the cells of the cortex. 



MEDICAL AND SURGICAL EMERGENCIES. 381 

The sensation of fatigue is in a certain sense a guaranty of 
safety for the muscular apparatus. In certain pathological 
states, often even by the energy of the will alone it may be 
overcome. But there then follows a still greater realization of 
fatigue, which may be the result of complete exhaustion. 

Normal fatigue easily leads on to a condition of sluggish- 
ness and languor known as sleepiness. The eyelids feel heavy, 
the muscles relax, there is an instinctive disposition to shirk 
work, an inability to fix the attention on anything whch re- 
quires thought, a sensation of supineness and enervation, a 
considerable obtuseness of the senses. Yawning is an indica- 
tion of weariness. "The head nods and droops upon the breast, 
and the body assumes that position which is most conducive to 
ease, comfort, and entire muscular inactivity." 

Another subjective antecedent of sleep is failure of the at- 
tention. To this end absence of sensorial impressions is an im- 
portant condition of sleep. There are certain influences which 
are predisposing causes, such as darkness and silence and mus- 
cular rest. 

Habitual sensation, as the continuance of an accustomed 
sound, are of the same class. It is owing to the power of habit 
that some persons can sleep more soundly in the neighborhood 
of noisy mills and cataracts, than elsewhere, the attention of 
the individual being more attracted by the suspension of the 
sound than by its continuance ; for as the exercise of the atten- 
tion implies an awakened and concentrated consciousness, dur- 
ing such exercise sleep is, in the nature of the case, impossible. 
Other predisposing causes are gentle tranquilizing sounds, such 
as the piping of crickets, the rustling of foliage, the hum of 
bees, hearing a dull book read, etc., which conduce to sleep by 
making on the sensorium a series of monotonous impressions 
which are neither interesting enough, nor powerful enough to 
keep the attention aroused. 

AMOUNT OE SLEEP NECESSARY. 

As sleep is a constructive process, it would seem that the 
amount of sleep taken should be proportionate to the mental 
and physical exercise of the waking hours. The reparative 



382 MEDICAL AND SURGICAL EMERGENCIES. 

value of sleep, however, is more dependent on the depth and 
intensity of the sleep than on its duration. The invigoration 
which follows sound, dreamless sleep is remarked by every one ; 
a little sleep of this kind is worth many hours of disturbed, 
dreamy sleep. It would seem that absolute quiescence and 
suspension of function is that condition of the cortical cells 
most favorable for nutrition and repair. 

The principle of making up for lost sleep is a correct one ; 
persons habituated to six or seven hours sleep a day may pass 
without inconvenience a night or two without sleep, provided 
they can make up for this loss by a more prolonged sleep after- 
wards. 

It is by dint of the habit of sleeping profoundly when they do 
sleep, that some persons sleep but few hours out of the twenty- 
four, and yet continue in health. Frederick the Great and John 
Hunter are said to have required only five hours of sleep a day ; 
Pitt used to restrict himself to three hours. The briefest sleep- 
ers are generally men of the greatest mental activity. The best 
scholars, thinkers and literary men, according to Carpenter, 
do not spend more than one-fourth of the diurnal cycle in sleep. 

. Persons of lymphatic temperament are said to be the great- 
est sleepers, from natural lethargy of the nervous centers. 

Hard, muscular toil promotes somnolence more than hard 
brain work ; the husbandman or day laborer sleep longer and 
more profoundly than the student or professional man. The 
waking state of such persons is characterized by great activity ; 
the wear and tear of the muscular system is immense, and long 
seasons of rest are needed, during which the physical and vital 
energies shall be largely occupied with the work of muscular 
reparation. 

Blood goes from the brain to the muscle, and there is rela- 
tive anemia of the cortex, a condition favorable to the inertia 
of sleep. Moreover, the cerebral activity of even the humblest 
day laborer is not inconsiderable — the sensory, perceptive, and 
voluntary faculties are kept constantly employed during their 
daily occupations. They often toil for hours in obedience to 
a painful exercise of the will, amid an almost overpowering 
sense of muscular weariness. Now, a purely voluntary act 
fatigues the brain more than an involuntary or automatic one. 



MEDICAL AND SURGICAL EMERGENCIES. 383 

Hence, the protracted sleep of the clay laborer must be due in 
a considerable degree to cerebral waste. 

The relationship of muscular exercise and muscular fatigue 
to the intra-cranial energies and circulation may not be demon- 
strably clear but the fact is none the less certain that muscular 
exertion is one of the most powerful promoters cf sound sleep. 

dreams. 

Dreams, from a psychological point of view, constitute the 
most interesting phenomena connected with sleep ; from a 
medico-physiological point of view, they are chiefly of interest 
as indicating that sleep is not sound, or only partial. 

In dreams, the cerebrum is in part awake ; the automatic 
centers of mind resume a measure of their activity, while the 
will is still dormant. A limited area of brain is brought into a 
condition of waking excitement ; certain ideas and emotions 
result, which, not being modified by comparison, and reflection 
by other ideas and feelings which are asleep, present a phantas- 
niagorical succession of images to the consciousness. 

Dreams are principally of interest to the physician as being 
an indication of unsound sleep. The dreaming period seldom 
comes on in health till the time for waking approaches. Then 
the centers that are most automatic, one by one recover their 
functional activity, those which represent the higher mental 
powers still remaining dormant. It is doubtless true that in 
sound, sleep we never dream. The condition of sound sleep is 
one of complete psychical inertia. 

If the dreaming period comes on early, it is evidence of some 
irritation in some part of the body which is disturbing the rest 
of the brain. Thus, unseasonable dreaming is often symptomatic 
of indigestion, teething, a febrile condition, the influence of 
some toxic agent (tea, coffee, alcohol, etc.), and when dreams 
become pathological, it is necessary for a physician to discover 
the cause and remedy it. 

INSOMNIA. 

If the essential condition of sleep be torpor of the centers of 
conscious mentality, everything which excites these centers and 
keeps them functionally active will promote insomnia. 



384 MEDICAL AND SURGICAL EMERGENCIES. 

In discussing the causes of insomnia I consider two divisions : 
Psychical and Physical. 

Under the head of Psychical Insomnia are included cases of 
sleeplessness due to mental emotion, to thought, worry, etc. 
Insomnia of the psychical order is illustrated in the student who 
is anxious about his examinations and cannot sleep until the 
result is known ; in the candidate for political honors who can- 
not sleep until the election is over and his fate is decided ; in 
the mother who will watch over her sick child night after night, 
not sleeping till the crisis of the sickness is past. Multitudes of 
such instances happen in daily experience. In order that 
natural sleep may occur, the mind must be tranquil. 

The pure hypnotics — chloral, paraldehyd, urethan, sulphonal — - 
given according to directions of physician, are generally quite 
efficacious in the insomnia due to emotional causes, the inten- 
sity of the insomnia being of course proportional to the inten- 
sity of the disturbing cause. Business cares and anxieties of 
all kinds, and homesickness and disappointments, often pro- 
duce a most obstinate wakefulness, which hardly yields to even 
large doses of chloral ; sulphonal is almost without effect. 

Under the head of Physical Insomnia, I shall first, take up 
the group of physical causes, foremost among which are or- 
ganic conditions productive of pain. If an irritation emanating 
from any organ or tissue may keep consciousness aroused and 
the brain active when not painful, how much the more likely to 
produce insomnia when raised to that degree of intensity 
known as pain. 

Pain may be due to inflammatory states of the nerve centers 
or their membranes, or to functional disturbances of nerves, 
constituting neuralgia ; to conditions of anemia or hyperemia ; 
to inflammation and suppuration ; to ulcerative processes ; to 
the pressure of tumors, exudations, etc. 

The first thing to be accomplished is to remove the cause, 
if possible. Sometimes this is an easy thing to do, as when the 
pain is from a tooth or an abscess ; on the other hand there are 
times when a narcotic is imperatively required. In antipyrin, 
phenacetin, acetanilid, we may often find good and compara- 
tively harmless substitutes for opium or morphine, and when 



MEDICAL AND SURGICAL EMERGENCIES. 385 

the former prove sufficient to quell the pain, they should always 
have the preference. ' 

INSOMNIA DUE TO OVERWORK OF THE BRAIN. 

Prolonged study, constant application to business, literary 
undertakings, speculative enterprises, etc., demanding vigilant 
thought and entailing much worry and anxiety are fruitful 
sources of insomnia. At the same time, exhaustive mental toil 
may be carried on with impunity provided the hours of sleep 
be not interfered with, and that suitable seasons of relaxation 
and diversion be snatched during the working hours. It is 
unremitting mental toil and worry that kills. 

With regard to the treatment of insomnia from mental over- 
work, the first cause demands attention. The student must 
curtail his studies, his hours of work ; must take more rest, 
more recreation, more exercise. The appearance of insomnia, 
or dreamy, restless, unrefreshing sleep in children should gen- 
erally be the signal for removing them for a time from school 
and providing suitable sports and recreations, a course of gym- 
nastics, and other measures calculated to invigorate, subdue rest- 
lessness, and procure natural sleep. 

In comparatively tractable cases of insomnia from overwork, 
a tablespoonful or two of old whiskey at bed-time will often 
work like a charm ; while many a glass of bitter ale has a still 
better effect. 

Muscular exercise before going to bed — a long walk in the 
open air, dumb-bell exercise, etc., is often of benefit. Sleep 
is much more certain to follow muscle-tire than brain-tire. 

Any one troubled with insomnia should avoid, particularly 
in the evening, indulgence in tea, coffee, tobacco or spirits ; 
also from reading, writing and other mental labor. 

The application of cold to the head, hot foot bath or the 
general warm bath, are often of benefit ; or the trunk and limbs 
may be bathed with cold water, followed by a brisk rubbing 
to induce a reactionary glow. The patient should cultivate the 
habit of going to bed at a regular hour, and of rising with 
punctuality. The bed-room should be well ventilated, and the 
head raised upon a high pillow. 
25 



386 MEDICAL AND SURGICAL EMERGENCIES. 

The diet must be adapted to the temperament and digestive 
powers, the last meal being taken some three hours before 
going to bed. On account of its stimulant and derivative action, 
turpentine in thirty-drop doses at bed-time is a powerful aid 
to sleep. It is easily taken in capsules. If it is found neces- 
sary to resort to hypnotics, the bromides are seviceable. 

To restore tone to the nervous system, a combination of 
nux vomica with hydrobromic acid is efficacious. 

Hydrobromic acid, 6 drachms. 

Tinct. nux vomica, 2 drachms. 

Water, to make 6 ounces. 

A tablespoonful in a wineglassful of water twice a day, be- 
fore meals. 

INSOMNIA RESULTING FROM DIGESTIVE DISTURBANCE. 

That indigestion causes insomnia by exciting the cerebrum 
is a matter of common experience. With many persons, even 
the active exercise of digestion, if this be at all difficult, is in- 
compatible with sound sleep. Such individuals refrain from 
lunching or partaking of a hearty meal before going to bed. 
Some can not drink a glass of milk or eat a biscuit late in the 
evening without atoning for the indiscretion by hours of sleep- 
lessness. 

One of the most frequent symptoms of indigestion is flatu- 
lence. The stomach is inflated and distressed by the gases of 
decomposition ; the distended stomach presses on the thoracic 
organs, embarrassing the heart and causing troublesome pal- 
pitations. 

However, in persons with healthy stomachs and normal 
arterial tone the digestive process is not prejudicial to sleep. 
Somnolence, in fact, often attends digestion, especially after a 
hearty meal. This has been attributed to the flushing of the 
stomach — at the expense of the cerebrum — which is a necessary 
condition of its function. 

Digestion normally occurs without attracting the conscious- 
ness and there is no reason why on proper occasions sleep 
should not follow a hearty meal in men as well as in carnivo- 
rous animals. 

Insomnia naturally comes in as one of the consequences of 



MEDICAL AND SURGICAL EMERGENCIES. 387 

over-eating and over-drinking, for a burdened stomach will 
not let the brain rest. Food should be eaten slowly and 
thoroughly masticated ; those that "bolt" their food are sure to 
eat to excess. 

Indigestibe foods, including foods improperly or insufficiently 
cooked, and foods that most persons of sedentary habits find 
hard to digest, as unripe fruit, pastries, hot bread, fried pork, 
confectionery, should be avoided. Of course much depends 
upon the muscular work done ; it is, especially, those of 
sedentary habits that are upset by a rich diet. 

Again, foods of themselves sufficiently digestible may be- 
come indigestible if too many kinds are eaten at a meal. This 
brings us again to the evils of excessive eating. 



SOME VALUABLE PRESCRIPTIONS FOR 
HEADACHES OF VARIOUS ORIGIN. 

Uraemic headache with deficient renal action. 

Citrate potash, i scruple. 

Inf. digitalis, y 2 ounce. 

Inf. buchu, y 2 ounce. 
This amount 3 times a day. 

Or 

Citrate potash, 1 scruple. 

Spts. juniper, 1 drachm. 

Sweet spts. nitre, 20 minims. 

Decoc. scoparii, 1 ounce. 
This amount 3 times a day. 

Headache from malarial poisoning. 
Disulphate quinine, 10 to 15 grains. 
Sulph. acid diL> 10 minims. 
Syrup, 2 drachms. 
Water, to make iy 2 ounces. 
To be taken 2 or 3 hours before the expected paroxysm 
and afterwards a third part 3 times a day till cinchonism is pro- 
duced. Should the headache recur from time to time give the 
following : 

Fowler's solution, 1 drachm. 
Tinct. belladonna, 1 drachm. 
Water, to make ij4 ounces. 
A teaspoonful in wineglass of water 3 times a day. 

Neuralgic headache with history of syphilis. 

Liq. arsenate potass., 1 drachm. 

Tinct. quinine, i]/ 2 ounces. 

Bichloride hydr., y 2 grain. 

Water, to make 6 ounces. 
A teaspoonful in wineglass of water 3 times a day after food. 

388 



MEDICAL AND SURGICAL EMERGENCIES. 389 

Headache associated with gouty diathesis. 

Liq. arsenate potass., 1 drachm. 

Liq. potassae, 1 drachm. 

Tinct. colchici, 2 drachms. 

Tinct. lavandulae co., 3 drachms. 

Water, 6 ounces. 
A tablespoonful in wineglass of water twice a day after food. 

Dyspeptic headache with flatulence, acidity and pyrosis. 

Bicarbonate soda, 1 drachm. 

Bismuth subcarb., 1 drachm. 

Pulv. acacia, 1 drachm. 

Aromatic spts. ammonia, 2 ounces. 

Syrup ginger, 3 ounces. 

Water, to make 8 ounces. 
Two tablespoonfuls 3 times a day half an hour before food. 

Bilious headache with flatulence. 
Sulphate magnesia, 6 drachms. 
Carbonate magnesia, 1 drachm. 
Tinct. lavandulae co., 3 ounces. 
Peppermint water, to make 8 ounces. 
A sixth part to be taken early in the morning and repeated 
as may be necessary. 

Neuralgic headache with constipation. 

Disulphate quinine, 12 grains. 

Dil. sulphuric acid, y 2 drachm. 

Tinct. perchloride iron, 2 drachms. 

Spts. chloroform, 2 drachms. 

Sulphate magnesia, 1J/2 ounces. 

Syrup ginger, 1 ounce. 

Water, to make 12 ounces. 
Two tablespoonfuls three times a day. 

Congestive headache. 

Ammonia bromide, 1 drachm. 

Aromatic spts. ammonia, J / 2 drachm. 

Water, to make iy 2 ounces. 
To be taken on rising in the morning. 



390 MEDICAL AND SURGICAL EMERGENCIES. 

Neuralgic and nervous headache marked by general debility 
and defective nutrition. 

Calcis hypophos. 80 grains. 

Tinct. perchloride iron, 3 drachms. 

Disulphate quinine, 16 grains. 

Strychnine, ^4 grain. 

Spts. choloroform, 2 drachms. 

Syrup, 1^2 ounces. 

Water, to make 8 ounces. 
A tablespoonful 3 times a day in a wineglass of water. 



NURSING. 

Ventilation and Warming — Taking Food — What Food? — 
Bed and Bedding — Light — Cleanliness of Rooms and 
Walls — Personal Cleanliness — Chattering Hopes and 
Advices. 

disease a reparative process. 

Shall we begin by taking it as a general principle — that all dis- 
ease, at some period or other of its course, is more or less a 
reparative process, not necessarily accompanied with suffering: 
an effort of nature to remedy a process of poisoning or of decay, 
which has taken place weeks, months, sometimes years beforehand, 
unnoticed, the termination of the disease being then, while the 
antecedent process was going on, determined? 

In watching diseases, both in private houses and in public 
hospitals, the thing which strikes the experienced observer most 
forcibly is this, that the symptoms or the sufferings generally con- 
sidered to be inevitable and incident to the disease are very often 
not symptoms of the disease at all, but of something quite different 
— of the want of fresh air, or of light, or of warmth, or of quiet, 
or of cleanliness, or of punctuality and care in the administration 
of diet, of each or of all of these. And this quite as much in 
private as in hospital nursing. 

The reparative process which Nature has instituted and which 
we call disease, has been hindered by some want of knowledge 
or attention, in one or in all of these things, and pain, suffering, 
or interruption of the whole process sets in. 

If a patient is cold, if a patient is feverish, if a patient is faint, 
if he is sick after taking food, if he has a bed-sore, it is generally 
the fault not of the disease, but of the nursing. 



391 



392 MEDICAL AND SURGICAL EMERGENCIES. 

WHAT NURSING OUGHT TO DO. 

I use the word nursing for want of a better. It has been 
limited to signify little more than the administration of medicines 
and the application of poultices. It ought to signify the proper 
use of fresh air, light, warmth, cleanliness, quiet, and the proper 
selection and administration of diet — all at the least expense of 
vital power to the patient. 

NURSING THE SICK LITTLE UNDERSTOOD. 

It has been said and written scores of times, that every woman 
makes a good nurse. I believe, on the contrary, that the very ele- 
ments of nursing are all but unknown. 

By this I do not mean that the. nurse is always to blame. Bad 
sanitary, bad architectural, and bad administrative arrangements 
often make it impossible to nurse. But the art of nursing ought 
to include such arrangements as alone make what I understand by 
nursing, possible. 

NURSING THE WELL. 

The very elements of what constitutes good nursing are as 
little understood for the well as for the sick. The same laws of 
health or of nursing, for they are in reality the same, obtain 
among the well as among the sick. The breaking of them pro- 
duces only a less violent consequence among the former than 
among the latter, — and this sometimes, not always. 

It is constantly objected, — "But how can I obtain this medical 
knowledge? I am not a doctor. I must leave this to doctors." 

VENTILATION AND WARMING. 

The very first canon of nursing, the first and the last thing 
upon which a nurse's attention must be fixed, the first essential to 
a patient, without which all the rest you can do for him is as noth- 
ing, with which I had almost said you may leave all the rest alone, 
is this : To keep the air he breathes as pure as the external 
air, without chilling him. Yet what is so little attended to? 
Even where it is thought of at all, the most extraordinary miscon- 
ceptions reign about it. Even in admitting air into the patient's 



MEDICAL AND SURGICAL EMERGENCIES. 393 

room or ward, few people ever think, where that air comes from. 
It may come from a corridor into which other wards are venti- 
lated, from a hall, always unaired, always full of the fumes of gas, 
dinner, of various kinds of mustiness ; from an underground 
kitchen, sink, washhouse, water-closet, or even, as I myself have 
had sorrowful experience, from open sewers loaded with filth ; 
and with this the patien f s room or ward is aired, as it is called 
— poisoned it should be racher said. Always air from the air with- 
out, and that, too, through those windows, through which the air 
comes freshest. From a closed court, especially if the wind does 
not blow that way, air may come as stagnant as any from a hall 
or corridor. 

Again, a thing I have often seen both in private houses and 
institutions. A room remains uninhabited ; the fire-place is care- 
fully fastened up with a board ; the windows are never opened ; 
probably the shutters are kept always shut ; perhaps some kind of 
stores are kept in the room; no breath of fresh air can by possi- 
bility enter into that room, nor any ray of sun. The air is as 
stagnant, musty, and corrupt as it can by possibility be made. It 
is quite ripe to breed smallpox, scarlet fever, diphtheria, or any- 
thing else you please. 

Yet the nursery, ward, or sick room adjoining will positively be 
aired (?) by having the door opened into that room. Or chil- 
dren will be put into that room, without previous preparation, to 
sleep. 

WITHOUT CHILL. 

With a proper supply of windows, and a proper supply of fuel 
in open fire-places, fresh air is comparatively easy to secure when 
your patient or patients are in bed. Never be afraid of open 
windows then. People don't catch cold in bed. This is a popu- 
lar fallacy. With proper bed-clothes and hot bottles, if neces- 
sary, you can always keep a patient warm in bed, and well venti- 
late him at the same time. 

But a careless nurse, be her rank and education what it may, 
will stop up every cranny and keep a hot-house heat when her 
patient is in bed, — and, if he is able to get up, leave him com- 
paratively unprotected. The time when people take cold (and 
there are many ways of taking cold, besides a cold in the nose), 



394 MEDICAL AND SURGICAL EMERGENCIES. 

is when they first get up after the two-fold exhaustion of dressing 
and of having had the skin relaxed by many hours, perhaps days, 
in bed, and thereby rendered more incapable of re-action. Then 
the same temperature which refreshes the patient in bed may de- 
stroy the patient just risen. And common sense will point out, 
that, while purity of air is essential, a temperature must be 
secured which shall not chill the patient. Otherwise the best 
that can be expected will be a feverish re-action. 

To have the air within as pure as the air without, it is not 
necessary, as often appears to be thought, to make it as cold. 

In the afternoon again, without care, the patient whose vital 
•powers have then risen often finds the room as close and oppres- 
sive as he found it cold in the morning. Yet the nurse will be 
terrified, if a window is opened. 

open windows. 

I know an intelligent, humane house surgeon who makes a 
practice of keeping the ward windows open. The physicians and 
surgeons invariably close them while going their rounds ; and the 
house surgeon very properly as invariably opens them whenever 
the doctors have turned their backs. 

In a little book on nursing, published a short time ago, we are 
told, that, "with proper care it is very seldom that the windows 
cannot be opened for a few minutes twice in the day to admit 
fresh air from without." I should think not; nor twice in the 
hour either. It only shows how little the subject has been 
considered. 

WHAT KIND OF WARMTH DESIRABLE. 

Of all methods of keeping patients warm the very worst cer- 
tainly is to depend for heat on the breath and bodies of the sick. 
I have known a medical officer keep his ward windows hermet- 
ically closed. Thus exposing the sick to all the dangers of an 
infected atmosphere, because he was afraid that, by admitting 
fresh air, the temperature of the ward would be too much lowered. 
This is a destructive fallacy. 

To attempt to keep a ward warm at the expense of making the 



MEDICAL AND SURGICAL EMERGENCIES. 395 

sick repeatedly breathe their own hot, humid, putrescing atmos- 
phere is a certain way to delay recovery or to destroy life. 

BEDROOMS ALMOST UNIVERSALLY FOUL. 

Do you ever go into the bed-rooms of any persons of any class, 
whether they contain one, two, or twenty people, whether they 
hold sick or well, at night, or before the windows are opened in 
the morning, and ever find the air anything but unwholesomely 
close and foul? And why should it be so? And of how much 
importance it is that it should not be so? During sleep, the 
human body, even when in health, is far more injured by the 
influence of foul air than when awake. Why can't you keep the 
air all night, then, as pure as the air without in the rooms you 
sleep in? But for this, you must have sufficient outlet for the 
impure air you make yourselves to go out; sufficient inlet for 
the pure air from without to come in. You must have open 
chimneys, open windows, or ventilators ; no close curtains round 
your beds ; no shutters or curtains to your windows, none of the 
contrivances by which you undermine your own health or destroy 
the chances of recovery of your sick. 

WHEN WARMTH MUST BE MOST CAREFULLY LOOKED TO. 

A careful nurse will keep a constant watch over her sick, es- 
pecially weak, protracted, and collapsed cases, to guard against the 
effects of the loss of vital heat by the patient himself. In certain 
diseased states much less heat is produced than in health ; and 
there is a constant tendency to the decline and ulitmate extinction 
of the vital powers by the call made upon them to sustain the heat 
of the body. Cases where this occurs should be watched with the 
greatest care from hour to hour, I had almost said from minute to 
minute. The feet and legs should be examined by the hand from 
time to time, and whenever a tendency to chilling is discovered, 
hot bottles, hot bricks, or warm flannels, with some warm drink, 
should be made use of until the temperature is restored. The 
fire should be, if necessary, replenished. Patients are frequently 
lost in the latter stages of disease from want of attention to such 
simple precautions. The nurse may be trusting to the patient's 



396 MEDICAL AND SURGICAL EMERGENCIES. 

diet, or to his medicine, or to the occasional dose of stimulant 
which she is directed to give him, while the patient is all the while 
sinking from want of a little external warmth. Such cases happen 
even during the height of summer. This fatal chill is most apt 
to occur towards early morning at the period of the lowest tem- 
perature of the twenty-four hours, and at the time when the effect 
of the preceding day's diets is exhausted. 

Generally speaking, you may expect that weak patients will 
suffer cold much more in the morning than in the evening. The 
vital powers are much lower. If they are feverish at night, with 
burning hands and feet, they are almost sure to be chilly and 
shivering in the morning. But nurses are very fond of heating 
the foot-warmer at night, and of neglecting it in the morning, 
when they are busy. I should reverse the matter. 

All these things require common sense and care. Yet perhaps 
in no one single thing is so little common sense shown, in all 
ranks, as in nursing. 

COLD AIR NOT VENTILATION, NOR FRESH AIR A METHOD OF CHILL. 

The extraordinary confusion between cold and ventilation, even 
in the minds of well educated people, illustrates this. To make 
a room cold is by no means necessarily to ventilate it. Nor is it 
at all necessary, in order to ventilate a room, to chill it. Yet, if a 
nurse finds a room close, she will let out the fire, thereby making 
it closer, or she will open the door into a cold room, without a fire, 
or an open window in it, by way of improving the ventilation. 
The safest atmosphere of all for a patient is a good fire and an 
open window, excepting in extremes of temperature. (Yet no 
nurse can ever be made to understand this.) To ventilate a small 
room without draughts of course requires more care than to venti- 
late a large one. 

NIGHT AIR. 

Another extraordinary fallacy is the dread of night air. What 
air can we breathe at night but night air ? The choice is between 
pure night air from without and foul night air from within. Most 
people prefer the latter. An unaccountable choice. What will 
they say if it is proved to be true that fully one-half of all the 



MEDICAL AND SURGICAL EMERGENCIES. 397 

disease we suffer from is occasioned by people sleeping with their 
windows shut? An open window most nights in the year can 
never hurt any one. This is not to say that light is not necessary 
for recovery. In great cities, night air is often the best and purest 
air to be had in the twenty-four hours. I could better understand 
in towns shutting the windows during the day than during the 
night, for the sake of the sick. The absence of smoke, the quiet, 
all tend to making night the best time for airing the patients. 

SMOKE. 

If we are to preserve the air within as pure as the air without, 
it is needless to say that the chimney must not smoke. Almost all 
smoky chimneys can be cured — from the bottom, not from the top. 
Often it is only necessary to have an inlet for air to supply the fire, 
which is feeding itself, for want of this, from its own chimney. 
On the other hand almost all chimneys can be made to smoke by a 
careless nurse, who lets the fire get low and then overwhelms it 
with coal ; not, as we verily believe, in order to spare herself 
trouble (for very rare is unkindness to the sick), but from not 
thinking what she is about. 

AIRING DAMP THINGS IN A PATIENT' S ROOM. 

In laying down the principle that the first object of the nurse 
must be to keep the air breathed by her patient as pure as the air 
without, it must not be forgotten that everything in the room 
which can give off effluvia, besides the patient, evaporates itself 
into his air. And it follows that there ought to be nothing in the 
room, excepting him, which can give off effluvia or moisture. Out 
of all damp towels, etc., which become dry in the room, the damp, 
of course, goes into the patient's air. Yet this "of course" seems 
as little thought of, as if it were an obsolete fiction. How very 
seldom you see a nurse who acknowledges by her practice that 
nothing at all ought to be aired in the patient's room, that nothing 
at all ought to be cooked at the patient's fire ! 

CHAMBER UTENSILS WITHOUT LIDS. 

The use of any chamber utensil without a lid should be utterly 
abolished, whether among sick or well. You can easily convince 



398 MEDICAL AND SURGICAL EMERGENCIES. 

yourself of the necessity of this absolute rule, by taking one with 
a lid, and examining the under side of that lid. It will be found 
always covered, whenever the utensil is not empty, by condensed 
offensive moisture. Where does that go, when there is no lid ? 

FUMIGATIONS. 

Let no one ever depend upon fumigations, "disinfectants," and 
the like, for purifying the air. The offensive thing, not its smell, 
must be removed. A celebrated medical lecturer began one day, 
"Fumigations, gentlemen, are of essential importance. They make 
such an abominable smell that they compel you to open the 
window." I wish all the disinfecting fluids invented made such 
an "abominable smell" that they forced you to admit fresh air. 
That would be a useful invention. 

HEAI/TH OF HOUSES. — FIVE POINTS ESSENTIAL. 

There are five essential points in securing the health of houses : 

1. Pure air. 

2. Pure water. 

3. Efficient drainage. 

4. Cleanliness. 

5. Light. 

Without these, no house can be healthy. And it will be un- 
healthy just in proportion as they are deficient. 



INDEX. 



Page 
Accidents and emergen- 
cies 73 

Things to be avoided . . 75 

Drowning 76 

Acid conditions of blood. . 205 
Acne — 

Definition, causes, symp- 
toms, treatment 262 

Prescription 263 

Air and water as rem- 
edies 347 

Angina pectoris 145 

Antitoxin in diphtheria.. 40 
Its manufacture and re- 
sult of its use 41 

Aphthae, thrush, canker 

sore mouth 278 

Definition, causes, symp- 
toms, treatment 279 

Appendicitis 279 

Definition, causes, symp- 
toms, treatment 273 

Artificial feeding of in- 
fants 337 

Artificial foods 31 

Asthma — 

Definition, causes 134 

Treatment 135 

Asthmatic attacks 113 

Bacteria 184 

Baldness 237 

Cause 238 

Treatment 239 

Prescriptions 240 



Page 
Biliousness and indiges- 
tion 123 

Blanching of the hair... 230-233 
Bleeders, (See hemor- 
rhages). 
Bleeding, (See hemor- 
rhages). 
Blood- 
Amount in body, compo- 
sition of the blood.. 10 
Body, compared to nature. 14 
Bones — 

Number, size, shape... 7 

Brain — 

Number and composi- 
tion of its cells, func- 
tion of various areas 
of the brain, weight 
of male and female 

brain 12 

Bran bath 210 

Breasts, broken — 

Definition, causes, symp- 
toms 276 

Treatment 277 

Breathing 339 

Bright's disease — 

Definition, symptoms.. 149 

Treatment 150 

Drinks, food, baths, ex- 
ercise, clothing 355-35S 

Bronchitis — 

Definition, causes, symp- 
toms, treatment 266 

Prescriptions 285 



399 



400 



INDEX. 



Page 
Burns — 

Forms, treatment 269 

Canker sore mouth 278,273 

Carbuncles — 

Prescriptions 304 

Catarrh of respiratory 
tract — 
Acute and chronic, 
description, causes, 

symptoms 132 

Treatment, prescrip- 
tions for internal and 

external use 133 

Prescriptions, nose, 

throat 286 

Bronchial tubes and 

lungs 287 

Acute nasal 305 

Of intestine 291 

Of bladder 292 

Change of life 166 

Chilblains — 
Prescriptions 304 

Chicken pox — 

Definition, symptoms . . 57 

Treatment 58 

Incubation, eruption... 283 

Child bed fever 334 

Chlorosis, or green sick- 
ness 273-274 

Cholera infantum — 

Definition 58 

Causes, symptoms 59 

Treatment 60 

Hygienic, medicinal. ... 61 

Prescriptions 293 

Cholera morbus 110 

Chorea or St. Vitus' 
dance — 

Definition 62 

Symptoms, contagious 

character, treatment . . 64 



Page 

Colic Ill 

Prescriptions 294 

Compress — 

Hot and cold 210 

Method of applying. . 211 
Physiological effects., 212 
Therapeutic applica- 
tions 212 

Hot and cold head 

compress 213 

Hot and cold lung 214 

Hot and cold kidney. . . 215 
Hot and cold gastro- 

hepatic 216 

Intestinal 216 

Hot and cold pelvic. . . . 217 

Hot or cold heating. .. . 217 

Physiological effects.. 217 
Hot and cold chest 

pack or compress . . . 219 
Hot and cold abdom- 
inal 219 

Use in vomiting 219 

Hot and cold lumbar 

packs 220 

Spinal 221 

Pelvic 221 

Therapeutic applica- 
tions 222 

Special forms of com- 
press 

Cephalic 222 

Physiological effects ... 223 
Therapeutic applica- 
tions 224 

Congestion of pelvic 
organs — 

Treatment 254 

Consumption of the lungs. 128 

Tubercular bacillus . . . 128 
Symptoms, general 

treatment 129 

Climatic treatment . . . 131 
Counter irritation — 

Value 350 



INDEX. 



401 



Page 
Croup 112 

Definition, kinds, causes. 55 

Symptoms, treatment... 56 

Death signs 255 

Death rate in infancy. ... 27 

Diabetes — 
Definition, varieties, 

diet, treatment 147 

Diagnosis of diseases 3 

Diarrhea — 
Prescriptions, children.. 297 

Adults Ill, 298 

Diet- 
Rules for diet of in- 
valids 202 

Fluid 202, 204 

Of child 28 

Digestion — 

Physiology of 159 

Diseases a reparative 

process 391 

Diphtheria — 

Definition 35 

Symptoms 36 

Cause, contagion, char- 
acter, treatment .... 37 
Tracheotomy, nursing, 

nourishment 38 

Prevention, antiseptic 

throat sprays 39 

Use of antitoxin 40, 41 

Dislocation of joints 116 

Douche 209 

Dreams 383 

Drowning — 

How to revive the 

drowning 76 

Dropsy — 

Prescriptions 299 

Drunkenness — 

Scientific side of 168 

Keeley and Witherel 
cure 169 



Page 

Drunkenness — Cwitinued. 
Treatment, prescrip- 
tions 169 

Views of Dr. Crothers 
of America and Kerr 

of England 171 

Duration of life of 

drunkard 172 

Duration of life when de- 
prived of air, sleep, 

water, or food 14 

Dyeing the hair various 

colors 243 

Prescriptions 244-251 

Dysmenorrhoea — 

Prescriptions 300, 165 

Dyspepsia — 
Prescriptions 301 



Ear — 
Power to perceive 

sounds is 

Diseases of, in children: 

Diagnosis 65 

Treatment 66 

Earache 114 

Eating — 
Excessive, as a cause of 

disease 372-373 

Eczema — 

Definition, causes, symp- 
toms, treatment, pre- 
scriptions 264 

Education of youth — 

Suggestions 374 

Electricity in treatment 

of diseases 252 

Reaction of muscle and 
nerve to electricity.. 255 

Emergencies — 

Medical and surgical 
supplies for emer- 
gencies 102 

Surgical case 103, 336 



402 



INDEX. 



Page 
Emergencies— Continued. 

Poultices 105 

Medicine chest 106 

Doses and uses of the 

medicines 107 

Epilepsy — 

Prescriptions 303 

Erysipelas — 

Definition, causes, symp- 
toms, treatment 151 

Essentials to health of 

houses 398 

Eye — 

Retina and optic nerve, 
power of color percep- 
tion 17 

Feeding children 32 

During first, second, 
and third years and 

thereafter 33 

Feigned diseases — 

Detection 255 

Flatulence — 

Prescriptions 306 

Food for the sick 195 

Gruels: 
Oatmeal, cornmeal, 

rice, farina flour... 196 

Nourishing drinks: 
Milk, rum, sherry, 
punch, hot milk and 
water, egg nog, oat- 
meal soup, beef tea, 
mutton broth, lemon- 
ade with egg, egg 
flip, lemonade, corn 
tea, crust coffee, tea, 
coffee, chocolate, tap- 
ioca, jelly, sago, ar- 
row-root milk, whip- 
ped cream, corn- 
starch pudding, beef 
juice, mint tea, cream 
soup, flaxseed lemon- 



Page 
Food for the sick — Continued. 

Nourishing drinks — 
ade, Irish moss lemon- 
ade, barley water, 
toast water, apple 
water, bran tea, wine 
whey, flaxseed tea.... 196-201 

Peptonized foods: 

Peptonized milk, 

gruel, beef tea 201 

Formula of various foods. 344-346 
Foot- 
Arrangement of ten- 
dons 14 

Foreign bodies removed 

from the eye 18 

Nose, ear 20 

Fractures of joints and 

dislocation of joints.. 116 

Causes of broken 
bones 116 

Variety of fractures, 
and symptoms 117 

Treatment of fractures. 118 

Dislocation of joints 
and causes, Dr. Lor- 
enz' methods 118 

Prominent symptoms.. 119 

Treatment 120 

Fumigations 398 

Gall stones 295 

Gargles — 

Prescriptions 288 

Germ theory in relation 
to causation of dis- 
eases 183 

Bacteria 184 

Rapidity of formation, 185 

Distribution 186 

Conditions necessary 

for growth 187 

Agencies destructive 
to bacterial life.... 188 



INDEX. 



403 



Page 
Germ theory — Continued. 

Bacteria — 
Infection, infectious 

principles 190 

Source of infection.. 191 

Transmission 192 

Where bacteria are 

found 193 

Infection of wounds, 
necessity for per- 
sonal cleanliness . . 194 
Gout- 
Diet in 205 

Gravel 295 

Green sickness or chlo- 
rosis — 

Definition 273 

Causes, symptoms, 
treatment, prescrip- 
tions 274 

Gruels 196 

Hair — 
Rapidity of growth, 

color, thickness 226 

Proper brush and comb. 227 

Hair of adults 228 

What to wash the hair 
with, treatment of 

ladies' hair 229 

Crimping and curling.. . 230 

Blanching 230, 231 

Causes 233 

Conditions influencing 

turning 234 

Treatment for loss of 

hair 235 

Prescriptions 236 

Hand — 

Growth of the finger 

nails 14 

Hay fever — 
Definition, causes, symp- 
toms, treatment, pre- 
scriptions 268 

Headaches in children... 375-377 



Page 
Heat and covering of 

body 25 

Heart and circulation of 

the blood 9 

Heart — 

Normal rate 9 

Comparison to a sta- 
tionary engine 9 

Size, shape, work ac- 
complished 9 

Description of diseases, 

fatty heart 136 

Treatment 137 

Palpitation of the heart. 137 

Causes, symptoms, 

treatment 138 

Heart failure or "broken 

heart" 138 

Symptoms 140 

Causes 141 

Injuries to heart and 
blood vessels, aneur- 
ism 142 

Effects of passion on 

heart 143 

Of anger, hatred, fear, 

grief 144 

Treatment of heart dis- 
eases • 144 

Angina pectoris, or neu- 
ralgia of the heart, 
causes, symptoms .... 145 
Hemorrhages and bleed- 
ing 92 

Course of larger ves- 
sels 92 

Course of arteries ■ 93 

Treatment of capillary 

hemorrhage 94 

Of venous 94 

For wounds high up 
in the arm, of arter- 
ies of the finger, of 
arteries of the hand 95 

Below the elbow, in 

the upper arm 96 



404 



INDEX. 



Page 



Hemorrhages — Continued. 




Of arteries of foot or 






97 


In the thigh, from 




arteries of the scalp 


98 




98 


Bleeders, description — 


99 


Special hemorrhages, 




bleeding from the 






100 


Bleeding from the nose, 






101 


Hemorrhoids or piles — 




Definition, causes 


271 


Symptoms, treatment, 




prescriptions 


272 


Hiccough — 




Causes, treatment, pre- 




scriptions 


122 


Hives — 




Nettlerash, wheals urti- 




c a r i a , definition, 




causes, symptoms, 






265 


Hygiene — 




Value 


339 


Hypochondria — 




Definition, cause, treat- 






260 


Hysteria — 




Definition, cause treat- 




ment 


260 


Incontinence of urine — 




Definition 


279 


Causes, treatment 


280 


Indigestion — 




Infantile, dietetic, man- 




agement 


341 


Milk substitutes 


342 


Indigestion and bilious- 




ness — 




Causes, treatment, pre- 






123 




190 



Page 
Inflammation of the bow- 
els — 

Prescriptions 302 

Influenza 154 

Prescriptions 305 

Ingrowing toe nail — 

Causes, treatment 277 

Insanity — 
Recognition and care of 
those mentally afflict- 
ed 176 

Common symptoms . . 177 

Diagnosis 178 

Early treatment 179 

Curability 180 

Institutional versus 

home treatment 181 

Prognosis or future of 
cases, variety of 
forms, symptoms .... 181 

Inhalations — 
Vapor, prescriptions . . . 289 

Spray 289 

Insomnia — 
Definition, treatment, 

prescriptions 261 

Due to overwork of 
brain and digestive 

disturbances 383-387 

Itch- 
Causes, treatment, pre- 
scriptions 266 

Irregular menstruation... 164 



Jaundice — 
Definition, causes, symp- 
toms, treatment 

Labor 


275 
327 


Suggestions to nurse . . 
Laws of nature 


331 
13 


La grippe or influenza — 
Definition, causes, symp- 


154 
155 



INDEX. 



400 



Page 
Leucorrhoea — 
Treatment, prescrip- 

tions 161 

Liver — 

Description cf affec- 
tions 157 

Functional derange- 
ments, symptoms, 

treatment 158 

Locomotor ataxia — 

Definition, symptoms, 
treatment, prescrip- 
tions 126 

Lungs — 

Muscles employed in res- 
piration, dimensions, 
normal rate of respi- 
ration 9 

Lying-in period — 
Diet 338 

Massage 349 

Maternity fever 333, 334 

Measles — 

Definition 47 

Cause and contagious 
character, period of 
exposure, symptoms.. 48 
Eruption stage, complica- 
tions 49 

Treatment 50 

Measles — 

German or French mea- 
sles, incubation, onset, 
eruption, contagion. . . 283 

Menorrhagia — 

Treatment 166 

Menstruation — 

Irregular 164 

Treatment 165 

Painful or dysmenor- 

hoea 165 

Cessation of 166 

Description of 167 



Milk, bottled— 
Preparation, administra- 
tion 278 

Milk from cow — 

Raw and boiled 29 

Milk, human 29 

Milk, goat's, substitute 

for mother's 30 

Miscarriages 327 

Moles 25 

Mortality in cities 27 

Mumps or parotiditis — 

Definition 62,307 

Symptoms, contagious 

character, treatment.. 63 
Muscles employed in 

speech 8 

Muscular system — 
Size and number of mus- 
cles 15 

Mustard foot bath 210 

Nausea or vomiting Ill 

Nervous attacks 113 

Nervous system — 

Nerves and nerve cells.. 15 

Neuralgia 115 

Varieties, causes 258 

Neurasthenia — 

Diet in 205 

Definition, causes, symp- 
toms, treatment 257 

Nose 18 

Nursing and care of child 27 

Nourishing drinks 196-201 

Nursing 391-398 

Little understood 392 

Ventilation and warm- 
ing 392 

Open windows 394 

Kind of warmth desir- 
able 394 

Foulness of bedrooms . . 395 

Cold air not ventilation. 396 



406 



INDEX 



Page 
Nursing- Continued. 

Night air 396 

Smoke 397 

Fumigations 398 

Obesity — 

Diet in 205 

Obligations between phy- 
sician and patient .... 2 
Obstetrical nurse 328 

Suggestions to nurse.. 329 

Ovarian tumors 162 

Treatment 163 

Overworking the undevel- 
oped brain 374 

Packs 217-222 

Perspiration 26 

Piles 271,272 

Pneumonia — 
Definition, causes, symp- 
toms, treatment 267 

Poisons — 
What to do in case of 

poisoning 80 

Kinds of: 

Unknown 80 

Acid 81 

Alkaline 81 

Metallic 82 

Vegetable 83 

Decayed meats or* vege- 
tables . . 84 

Table of various poisons 

and treatment 85 

Poison vine 114 

Pores 25 

Poultices 105 

Prescriptions — 

Valuable collection 285-306 

Selected patent medi- 
cines 306-321 

For headaches of vari- 
ous origin 388-390 



Page 
Pregnancy — 

First things to do 321 

Diet 322 

Care of breast and nip- 
ples 324 

Care of teeth 324 

Exercise 325 

Rest 325 

Bathing 325 

General health 326 

Clothing 326 

Miscarriages 327 

Preparations for labor. . 327 

Pulmonary consumption .. 128 



Renal calculi or gravel — 

Prescriptions 295 

Responsibilities of a phy- 
sician 4 

Retention of urine 280 

Rheumatism — 

Diet in 205 

Ringworm 251 

Treatment 251 

Russian bath 208 

Salt bath 210 

Scalds — 

Forms, treatment 269 

Scarlet fever 283 

Definition 41 

Complications 42 

Cause and contagious 

character 42 

Period of exposure, symp- 
toms, beginning of the 

eruption 43 

Treatment 44-46 

Scars 25 

Seeking a consultant.... 2 

Selection of a physician . . 1 
Sick headache — 

Causes, treatment 268 

Sitz bath 210 



INDEX. 



407 



Page 
Skin 21 

Structure, chief func- 
tions 22 

Removal of deformities. 23 

Skeleton — 

Weight 5 

Height 6 

Sleep — 
Physiology and neces- 
sity of 378-379 

Sense of fatigue 380 

Amount necessary 381-382 

Small pox — 
Incubation, onset, erup- 
tion, contagion 284 

Transference of conta- 
gion 359 

Diagnosis 360 

Disposition of a sus- 
pected case 361 

Isolation 362 

Quarantine rules 362 

Duties of nurse and at- 
tending physician .... 363, 364 

Disinfection 364 

Disinfection of premises 

and persons 365 

Mortality rate 367 

Proper disposition of the 

dead 367 

Suggestions to small pox 

nurses 368 

Vaccination 370-371 

Smell- 
Delicacy of sense 18 

Spectacles — 

When to be used 252 

Spine — 
Number and description 
of segments, function 
of spinal column .... 13 

Stammering — 

Cause and treatment. . . 351-35 1 
St. Vitus' dance or chorea — 
Definition 6°, 



Page 
St. Vitus' dance — Continued. 
Symptoms, cause of dis- 
ease, treatment 64 

Stomach — 
Comparison to a chem- 
ical labratory, number 
and shape of its diges- 
tive glands 8 

Amount of food con- 
sumed daily, annually, 
and in a life time .... 9 

Sunstroke — 

Cause 88 

Course of the disease, 

treatment 89 

Sweating of the feet — 
Treatment 251 

Teething — 

Description 67 

Treatment 68 

Temperature of body .... 25 

Throat- 
Size of vocal cords, num- 
ber of*different sounds 

produced 7 

Thrush 278; 279 

Tic douloureux — 

Definition, treatment . . 259 

Tobacco — 

Use, action on blood, ali- 
mentary canal, and 
nervous system 173 

Effects of smoking and 
chewing, with clinical 
examples, cigarette 
smoking 174 

Effect on boys, nicotine 
the most deadly poison, 

treatment 175 

Tongue — 

Distribution of sense of 
taste 7 



408 



INDEX. 



Page 

Tonics- 
Prescriptions 296 

Toothache 114 

Tonsils — 

Enlarged, treatment . . . 276 

Touch — 

Delicacy of sense 14 

Tracheotomy 38 

Uric acid producing foods. 348 

Urine — 

Incontinence 279,280 

Retention 280 

Vaccination 370-371 

Varicella or chicken pox — 

Definition, symptoms ... 57 

Treatment 58 

Varioloid or modified 

small pox 284 

Vegetarianism — 
Value 280 

Ventilation and warming. . 392 

Vertigo — 

Definition, causes 124 

Treatment, prescrip- 
tions 125 

Vomiting or nausea Ill 

Causes, treatment, pre- 
scriptions 121 



Page 

Warts 25 

Water — 

Its use 206 

Physiological effects . . . 207 

Cold and warm water. . 207 

Manner of application. . 208 

Wet pack — 

Rubbing wet pack 209 

White swelling — 
Definition, causes, symp- 
toms 270 

Treatment 271 

Whooping cough 113 

Definition, symptoms... 51 

Complications, diagnosis. 52 

Its nature and spread. . 53 

Treatment 54 

Convalescence 55 

Women — 
Diseases of 161-167 

Wonderful construction of 

the human body 5 

Worms in alimentary 

canal, various kinds.. 69 
Diseases due to them, 

prevention 70 

. Treatment 71 



SEP 23 1 . 




mm 



Wlfim 



SB 

Si 






